Introduction: Lymphadenopathy, marked by enlarged lymph nodes, poses diagnostic challenges. Fine Needle Aspiration Cytology (FNAC) emerges as a valuable tool, offering minimal invasiveness and cost-effectiveness. While FNAC is less ideal for lymphomas, it aids in distinguishing cervical organ issues. Globally, lymphadenopathy’s causes vary, with tuberculosis prevalent in developing nations like India. Aims and Objectives: The study focused on identifying common cytological patterns in lymph node lesions and correlating factors associated with these lesions. Materials and Methods: A prospective study was undertaken at Belagavi Institute of Medical Sciences focused on FNAC for clinically suspected lymph node lesions over a period of 12 months (July 2022-June 2023). Inclusive of all ages and genders, the study performed up to four FNAC attempts, with PAP and Giemsa staining for immediate evaluation. Granulomatous cases underwent Ziehl-Nielsen staining. Results: The study encompassed 252 cases with lymph node presentations, spanning ages 9 months to 85 years. The majority were males (152) compared to females (100). Cervical lymph nodes dominated presentations (208 cases), with 49 cases in the 10-20 age group. Malignant cases exhibited a male preponderance (51 cases) compared to females (21). Malignancies correlated significantly with age above 40 (p<0.00001). Metastatic squamous cell carcinoma prevailed (54 cases), notably in cervical lymph nodes. Tubercular lymphadenitis, predominantly in females, accounted for 27 cases. Despite left-sided prevalence, females showed slightly more right-sided cases. Overall, the study delineated age, gender, and pathology patterns in lymph node presentations. Conclusion: Fine Needle Aspiration Cytology (FNAC) serves as an excellent first line investigation for assessing the nature of lesions in lymph nodes, offers a reliable and readily acceptable diagnostic tool in the diagnosis of tuberculosis, primary and metastatic malignancies, reactive lymphadenitis and suppurative lesions as it is quick and minimally invasive procedure.

DOI: 10.5281/zenodo.10936175

Background: Breast malignancies are the most common clinical condition diagnosed amongst women worldwide. Ultrasonic elastography is a non-invasive diagnostic technique for detecting the mechanical properties of tissues and seems to compensate for the shortcomings of conventional Ultra Sonography (USG). This study aimed to evaluate the accuracy of ultrasound elastography for determination and characterization of different breast masses and to investigate its role in distinguishing between benign and malignant breast masses with Fine Needle Aspiration Cytology (FNAC) and histopathological correlation. Methods: A total of 252 patients with USG-confirmed breast lesions were included in this study, of which 12 were lost during follow-up and excluded. Finally 240 patients remain for the study. Consecutive individuals with palpable breast lesions were evaluated using standard B-mode USG. The patients proven to have a breast lesion were next examined using Strain Elastography (SE). FNAC was employed for histopathological confirmation of malignant breast lesions. The benign lesions were identified by a combination of FNAC and biopsy and were monitored for next six months. Results: Out of 240 suspected breast cancer 92 (38.3%) were malignant and 148 (61.7%) benign lesions. The mean stain ratio (SR) for benign lesions was 2.1, which was substantially less malignant lesions (4.2). When a cut-off value of 3.5 was utilized, the elasticity score showed 82.6% sensitivity and 92.8% specificity and the accuracy 88.2%. When a cut off of 2.95 was employed, SR scores showed 89.3% sensitivity and 89.6% specificity and accuracy 92.1%. Conclusions: Ultrasound elastography is a non-invasive, simple and quick procedure for improving the sensitivity, specificity and accuracy of USG and reducing the number of unwanted biopsies.

DOI: 10.5281/zenodo.10947499

Background: Adverse drug reactions (ADRs) are known causes for increased mortality, and morbidity. The aim of this study is to assess the knowledge, attitude, and practice of pharmacovigilance among the second year Medical, Pharmacy, Dental and Nursing students. Materials and Methods: This is a cross sectional questionnaire based study and 345 Health Care students from various branches of second year students were selected non-randomly as the participants. This study was conducted at CAIMS, Bommakal, Karimnagar. Institutional ethical committee approval was obtained from the Institution prior to the study. Pre-design validated and self administered Knowledge, attitude, and practices (KAP) questionnaire on Pharmacovigilance was structured in Google form and the link was sent to the students. The response was analyzed by chi – square test and one way ANOVA by using the SPSS software Version -20. Results: The distribution of knowledge about the pharmacovigilance in the MBBS students have more adequate knowledge 44 (24.6%) than other professional students and the dental students have poor knowledge 28 (34.1) than other professional students. The awareness   of ADRs reporting was higher in MBBS students 168(93.9%) than other professional students. Over all practice of ADR among the professional student showed more negative response. Conclusion: This study concluded that the continuous education and training about the PV and ADR reporting system is necessary for all healthcare students.

DOI: 10.5281/zenodo.10947555

Background and Objectives: Peripheral blood neutrophil-to-lymphocyte ratio (NLR) has recently emerged as a prognostic biomarker in many disease states. The aim of this study was to evaluate the diagnostic utility of NLR to predict poor functional outcomes in patients with hemorrhagic stroke and to compare it with the intracranial hemorrhage (ICH) score. Materials and Methods: Patients who presented to the emergency department with clinical features suggestive of stroke were evaluated with computed tomography (CT) brain to identify ICH. The ICH scores and NLR were estimated at the time of admission. Modified Rankin Scale (mRS) score equal to or greater than 3 at 90 days was used to define poor functional outcomes (major disability or death). Receiver operating characteristic (ROC) curve was plotted with NLR and the ICH score to analyze and compare their discriminative ability to predict poor functional outcomes. Conclusion: In patients with hemorrhagic stroke, NLR at admission is a good predictor of functional outcomes at 90 days. When compared to the ICH score, NLR is more sensitive but less specific in predicting poor functional outcomes.

DOI: 10.5281/zenodo.10947848

Background: A prominent cause of rickets is a deficiency in vitamin D. Recent researches have suggested that a lack of dietary calcium may be a contributing factor to its cause. The relative efficacy of calcium, vitamin D, or a combination of them in treating rickets is not well-established. Objective: To ascertain the effect of vitamin D therapy, calcium therapy, or a combination of the two on the nutritional rickets healing process in young children. Material and Methods: A randomized controlled experiment with 67 patients with nutritional rickets, ages ranging from six months to five years, was conducted. For a period of 12 weeks, they were randomized to receive either calcium (75 mg/kg/day elemental calcium orally), vitamin D (600000 IU single intramuscular injection), or a combination of the two. Each person’s demographic information, nutritional status, calcium intake from food, and phytate intake were assessed. In order to measure the degree of healing, baseline, 6-week, and 12-week radiographs of the wrist and knee as well as biochemical markers such as blood calcium, inorganic phosphate, alkaline phosphatase, 25-hydroxycholecalciferol, and parathyroid hormone were evaluated. Results: The average daily intake of calcium from food was 204.01 ± 129.01 mg, which was inadequate in every case. The mean serum 25-hydroxycholecalciferol D level was 15.91 ± 12.41 ng/ml. Serum vitamin D levels below 20ng/ml were found in 82.1% of the patients, suggesting a deficiency in vitamin D. After 6 and 12 weeks of treatment, all therapy groups showed some degree of radiological and biochemical signs of curing rickets, but to different degrees. Compared to 15.7% on vitamin D alone and 11.7% on calcium alone, 50% of patients on combination therapy attained the integrated end objective of normal blood alkaline phosphatase and complete radiographic healing at 12 weeks. Conclusion: Children who developed rickets had lower dietary calcium intake and a blood vitamin D deficit. The most effective treatment outcome was shown when vitamin D and calcium were combined, rather than when each was administered alone.

DOI: 10.5281/zenodo.10947928

Background: The coronavirus infection pandemic of 2019 (COVID-19) has grown into a new worldwide health catastrophe, impacting thousands of humans. COVID-19 produces a variety of symptoms, involving severe various organ failures, acute respiratory distress syndrome (ARDS), and loss of life. Several occurrences of fungal co-infection as well as super infection have been described in various researches. Materials and Methods: We included samples that were presented to the Department of Microbiology, Gandhi Medical College, Bhopal, for diagnosis of suspected fungal infection in the time period of April to June 2021 of individuals who had therapy for COVID-19 in the previous duration of three months or were presently receiving therapy for COVID-19. Samples were processed by Potassium hydroxide (KOH) wet mount preparation and fungal culture, microscopic identification was done, and data was collected in tabulated form. Results: Overall, out of 332 samples, 235(70.8%) showed fungal elements by potassium hydroxide wet mount preparation, and 204(61.4%) were culture-positive. Out of culture-positive specimens, 61(29.9%) were Rhizopus spp., 31(15.2%) were Mucor spp., 41(20.1%) were Aspergillus spp., 11(5.4%) were Candida spp., 32(15.7%) were Mucorales with Aspergillus, 19(9.3%) were Syncephalastrum spp., and 3% were other fungal species. Conclusion: Early screening and culture identification will aid in diagnosis, management, and treatment with anti-fungal agents, resulting in an improved prognosis in COVID-19 patients.

DOI: 10.5281/zenodo.10948036

Background: Adverse drug reactions (ADRs) are known causes for increased mortality, and morbidity. The aim of this study is to assess the knowledge, attitude, and practice of pharmacovigilance among the second year Medical, Pharmacy, Dental and Nursing students. Materials and methods: This is a cross sectional questionnaire based study and 345 Health Care students from various branches of second year students were selected non-randomly as the participants. This study was conducted at CAIMS, Bommakal, Karimnagar. Institutional ethical committee approval was obtained from the Institution prior to the study. Pre-design validated and self-administered Knowledge, attitude, and practices (KAP) questionnaire on Pharmacovigilance was structured in Google form and the link was sent to the students. The response was analyzed by chi – square test and one way ANOVA by using the SPSS software Version -20. Results: The distribution of knowledge about the pharmacovigilance in the MBBS students have more adequate knowledge 44 (24.6%) than other professional students and the dental students have poor knowledge 28 (34.1) than other professional students. The awareness   of ADRs reporting was higher in MBBS students 168(93.9%) than other professional students. Over all practice of ADR among the professional student showed more negative response. Conclusion: This study concluded that the continuous education and training about the PV and ADR reporting system is necessary for all healthcare students.

DOI: 10.5281/zenodo.10948115

Background: Video laryngoscopes are increasingly being used in potentially difficult airway. McCoy laryngoscope provides definitive advantage over conventional laryngoscopes in cervical spine patients. The present study was undertaken to compare the time taken for intubation, intubation difficulty scale (IDS) score and hemodynamic responses between McCoy and Truview video laryngoscope during tracheal intubation in cervical spine patients. Method: A total 50 patients of ASA grade I and II, aged 20–50 years, posted for emergency and elective cervical spine surgeries under general anaesthesia were randomly allocated into Group V (Video-laryngoscope group, n=25) and Group C (McCoy group, n=25). Results: Truview video laryngoscope required longer time (34.08seconds) for intubation as compared to McCoy laryngoscope (26.56seconds), which was statistically highly significant (p<0.001). Truview video laryngoscope provides better laryngoscopic view and makes intubation easy than McCoy laryngoscope. The number of cases in which the increased lifting force was required was significantly higher in McCoy group (56%) than Truview Video laryngoscope group (4%). More cases required external laryngeal pressure during intubation with McCoy laryngoscope (64%) as compared to Truview laryngoscope, (12%) (p=0.0001). Truview video laryngoscope makes lower IDS scores compared to McCoy laryngoscope. Hemodynamic responses during intubation were less with Truview video laryngoscope than McCoy laryngoscope. The complications encountered during laryngoscopy and intubation was similar and almost negligible in both groups. Conclusion: Thus, in patients who are undergoing cervical spine surgeries the Truview video laryngoscope offers a better alternative to MacCoy and conventional direct laryngoscopy by improving laryngoscopic view with lower CL grading and ease of intubation with minimal hemodynamic responses.

DOI: 10.5281/zenodo.10948177

Background: Osteoarthritis is the most common musculoskeletal disease leading to functional decline and loss in quality of life. Aim: To assess HRQOL, severity of pain and its impact on functioning and associated factors related to HRQOL among osteoarthritis patients. Methodology: Cross sectional study was conducted among 237 adult osteoarthritis patients aged ≥18 years attending Orthopaedic OPD, Government Stanley Medical College between July to September-2022 (3 months) through simple random sampling using validated pretested semi-structured questionnaire by face-face interview consisting of European Quality of Life scale 5 Dimension 5 level with Visual Analog Scale to assess HRQOL and Brief Pain Inventory to assess pain severity and interference. Data was entered in Microsoft Excel and analysed in SPSS 16 version. p value <0.05 was considered as statistically significant. Results: Average age of osteoarthritis patient is 59.53± 10.34. Out of 237 participants, 84% were females, 66.7% had good HRQOL, 70.5% with mild grading of pain severity, and 84% showed low functional interference due to pain. Multiple linear regression analysis showed age of the participant, disease duration, treatment status, pain severity and pain interference had significant impact on quality of life. Conclusion: Osteoarthritis patients with age, disease duration, pain severity and interference in daily function due to pain had negative impact on the quality of life of osteoarthritis patients.

DOI: 10.5281/zenodo.10948248

Aim:  To evaluate the reasons for delay in cataract surgery in unoperated other eye of patient who is pseudophakic in one eye. Material and Methods: In this prospective questionnaire based – single centre study, 200 patients with advanced cataract in one eye and pseudophakia in other eye for last 2 years were selected. Results: The patients were in the age group 55 years and above with Male: Female ratio of 70:30. The major reasons for delay in cataract surgery were lack of accompanying person (55%), loss of work / income (27%), did not feel necessity of surgery (11%), unsatisfactory vision in operated eye (6%), and coexisting systemic disease (5.5%). 12% patients believed that winter was appropriate time for cataract surgery. It is important to note that cost is not a factor in government hospitals since all cataract surgeries are free. Conclusions: Increasing public awareness of complications due to delay in cataract surgery, regular eye examination and increasing accessibility will provide a solution to the delayed cataract surgery uptake.

DOI: 10.5281/zenodo.10948307

Background: Pterion is the junction of the frontal, parietal, greater wing of the sphenoid and the squamous part of the temporal bone. The sphenoparietal, frontotemporal, stellate and epipteric pteria types were described earlier. Pterion is a commonly used neurosurgical landmark and thus in-depth knowledge of the pteric area and its variants could be valuable. The current study determines pterion morphology (variant types’ frequency), as well as the presence of epipteric bones in dried skulls. Materials and Methods: Fifty adult dried skulls of both right and left sides (100 sides) were observed for pterion types, symmetry, epipteric pterion subtypes, and sub-subtypes of the trisutural epipteric pterion subtype. The data was statistically analyzed. Results: The sphenoparietal pterion was the commonest type (78%), followed by epipteric (16%), frontotemporal pterion (4%) and by the stellate (2%). Pterion was symmetric in 40 (80%) of the skulls – 34 SP-SP type, 4 E-E type, 1 FT-FT type and 1 ST-ST type. In asymmetrically pairing skulls, the commonest pterion types were the SP-E (n=8; 16%) and the SP-FT (n=2; 4%). Of the epipteric pterion type, quadrisutural (6%), trisutural (6%), and multiple (1%) subtypes were observed in this study; bisutural subtype was not observed. Of the four sub-sub types of trisutural epipteric pterion, 5 posterior and 1 anterior were observed in this study; superior and inferior sub­subtypes was not observed. Conclusions: Recognition of the possible variability in pterion morphology, as well as possible occurrence of epipteric bones may render pterional craniotomy safer during neurosurgical procedures.

DOI: 10.5281/zenodo.10948365

Introduction: Hepatitis C virus (HCV) is a major health challenge affecting around 200 million people worldwide, causing liver fibrosis, cirrhosis, and cancer. Despite no vaccine, advancements in treatment have led to cures. In India, HCV causes up to 21% acute viral hepatitis and 14-26% chronic liver disease. HCV is classified into six genotypes and 67 subgenotypes, with India having genotype 3. Understanding viral persistence and transmission modes is crucial for HCV prevention and designing therapeutic strategies. Screening and quantification of HCV are crucial for diagnosis and treatment, and early identification can lead to effective antiviral therapies. HCV genotype also influences treatment, as RNA viruses evolve and respond differently across regions. Understanding genotype distribution is crucial for therapy efficacy and estimating disease burden in Tripura. HCV is a small, positive polarity, enveloped virus from the Hepacivirus genus, with a high mutation rate generating genetic diversity within hosts. Aims & Objective:  The study aims to analyze Hepatitis-C genotypic and clinical characteristics in GBPH and AGMC patients, examine their range, and estimate viral load to assess Sustained Virological Response. Methods: This observational study, conducted at the Dept. Of Medicine, AGMC & GBPH, aimed to analyze the impact of viral hepatitis on patients attending both the Obstetrics and Gynecology Outpatient Department (OPD) and the Inpatient Department (IPD). The study was conducted over two years, with a sample size of all patients meeting inclusion and exclusion criteria. The study used a predesigned proforma to collect demographic data, medical history, and clinical features. The study excluded cases with HCV already identified and receiving treatment. Results: The study analyzed data from 90 Hepatitis-C patients at Agartala Government Medical College and GBP Hospital, West Tripura, focusing on their history, examination, and laboratory tests. Discussion: The study on Hepatitis C (HCV) infection in Tripura, India, from January 2021 to June 2022, found that it is more prevalent among younger individuals due to drug use. The majority of patients were students under 30, with 23.3% being drivers. Intravenous drug use (IDUs) was the most common mode of transmission, followed by regular hemodialysis and multiple blood transfusions. Risk factors include unsafe sexual practices, IDU, injection practices, tattooing, and acupuncture. The study also found a significant reduction in HCV RNA after 12 weeks of antiviral therapy, achieving a 96% SVR. Conclusion: A study revealed that Chronic Hepatitis-C is primarily affecting the young generation, with mixed genotypic infections and a prevalence of 31%. The effectiveness of current DAAs and a national initiative are still being evaluated.

DOI: 10.5281/zenodo.10948447

Introduction: Melasma is a widespread, acquired hypermelanosis that usually affects the face and other sun-exposed regions. Asian or Hispanic women with Fitzpatrick III to V skin types are frequently affected. Available therapies include lasers, peeling chemicals, and topical depigmenting agents like hydroquinone. The effectiveness and safety of all these treatments are still for debate, despite their widespread use.  Because melasma recurs frequently, treating it can be quite difficult. Tranexamic acid (TA) has been added to the therapy of melasma, and several clinical trials conducted worldwide have demonstrated positive outcomes. In order to examine the effectiveness of topical hydroquinone and oral tranexamic acid, a prospective comparison research was carried out. Material and Method: This one-year, outpatient, tertiary care hospital’s Skin & VD department conducted a single-center, randomised, three-arm comparative prospective research. A tertiary care hospital in eastern India recruited 100 melasma patients between the ages of 20 and 60 who were attending dermatology outpatient clinics. The following patients were not allowed to participate in the study: those who were pregnant, nursing, had any history of coagulopathy, coronary heart disease, hypertension, diabetes mellitus, thrombosis, renal disease, mental illness, concurrent use of contraceptives, severe sunburn three months prior, use of anticoagulant or antiplatelet agents such as clopidogrel, topical steroids, oral and topical retinoid, hydroquinone, or topical bleaching agents, and lasers, among other conditions. Result: Ten patients did not come back for follow-up out of a total of 100 patients because of a delayed response or prolonged therapy. In the end, the 90 patients who finished the therapy regimen were taken into account. The female to male ratio was 3.74:1, with over half of the patients being in their third decade of life. The comparison of mean MASI score between Groups at 8 and 12 weeks with initial MASI score showed statistically significant with p-value=0.000 among oral tranexamic acid users. The mean MASI score was maintained after 6month in group using systemic tranexamic acid (1.062±0.92) in comparison to only topical or combination therapy. Conclusion: Melasma, which primarily affects women in their twenties causes symmetrical, chronic acquired hypermelanosis of the face or parts of the body exposed to the sun. Hydroquinone is one of the best treatments for treating melasma but remarkable facial side effects like ochronosis. Hence finding novel adjuvant therapies to boost the effectiveness of previous pharmaceuticals has become more difficult due to the lengthy treatment , side effects, and recurrence. Treatment for melasma has recently seen some optimism provided with the introduction of oral tranexamic acid (TA).

DOI: 10.5281/zenodo.10948506

Background and Aims: Laryngoscopy and tracheal intubation produces pressor and sympathoadrenal response leading to increase in heart rate, blood pressure, myocardial oxygen demand, and consequently potential dysrhythmias and myocardial ischemia/infarction. This study aimed to compare nebulized magnesium sulfate and lignocaine to attenuate the hemodynamic response to tracheal intubation and the incidence of POST. Materials and Method: Following ethics committee approval, a double-blinded randomized controlled trial assigned patients into two groups using computer-generated randomization. Vital signs (HR, SBP, DBP, MAP) were recorded, and ten minutes before anesthesia induction, Group B received 2% nebulised lignocaine (2mg/kg), while Group A got 250mg of nebulised magnesium sulfate. Vitals were checked post-intubation at 0, 2, 4, 6, and 10 mins along grading of POST. Results: Both groups (30 patients each), had similar baseline characteristics. Group B exhibited higher HR(87.50 ± 12.62), systolic(127.40 ± 13.20) and diastolic BP (83.27 ± 10.34), MAP(104.79 ± 8.35) compared to Group A [HR(80.33 ± 14.19), SBP(115.50 ± 14.18), DBP (74.20 ± 8.39) MAP(88.37 ± 8.70)](p<0.001) at time of intubation. Conclusion: Nebulised MgSO₄ is better than nebulised lignocaine in reducing the pressor response with no apparent side effects.

DOI: 10.5281/zenodo.10948554

Objectives: The present study was to evaluate the feto-maternal outcome and prevalence of pre-eclampsia at tertiary care hospital also to assess the maternal outcomes in terms of severity, complications of pre-eclampsia,  maternal mortality and to determine the neonatal outcome in pre-eclamptic women. The associated risk factors for pre-eclampsia in patients has also been analysed. Methods: A total of 100 patients with pregnancies complicated by the onset of pre-eclampsia were included. Diagnostic criteria for pre-eclampsia were Systolic blood pressure of 140 mmHg or more or diastolic blood pressure of 90 mmHg or more on 2 occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood pressure, Proteinuria of 300 mg or more per 24hour urine collection or dipstick reading +2 Or in the absence of proteinuria and new onset hypertension. Results: Most of the patients (49%) were in age group of 26-30 years. Maximum number of patients were primigravida 60%. 33% of patients had a typical vaginal delivery, 63% had a caesarean section, and 96% of patients were from lower socioeconomic classes. Oedema of feet and headache were two most common symptoms present in 80 (80.00%) and 62 (62.0%) patients respectively. Eclampsia (11%), HELLP syndrome (22%), and abruptio (8%) were the most common maternal complications. 100 new-borns, 37 (37.00%) had a normal result, 27% (27.00%) had low birth weight, 15 (15.00%) had IUGR, 14 (14.00%) had IUFD, 6 (6.00%) had RDS, and 1 (1.00%) was stillborn. Additionally, 40 (40.00%) kids were admitted to the NICU. Conclusions: Pre-eclampsia prevails  as a serious condition. Causes of death and morbidity in pregnant women and postpartum period is due to lack of proper antenatal care, lack of knowledge and education among low socioeconomic status individuals. Early prenatal diagnosis, evaluation, appropriate patient counselling, proper education can help in identifying the warning signs during the antepartum, intrapartum and postpartum period. Proper and timely ICU care is an important factor in management of patients having complications of pre-eclampsia. Timely referral of pre-eclampsia patients to tertiary care centre can save mothers life and also improve maternal and perinatal outcome in pre-eclampsia patients.

DOI: 10.5281/zenodo.10952467

Artificial intelligence (A.I.) is revolutionizing the diagnosis of infections, offering faster and more accurate methods. By rapidly detecting pathogens and identifying antibiotic resistance, A.I. enhances diagnostic capabilities. It plays a crucial role in early disease detection, drug development, personalized treatments, and timely outbreak detection, leading to significant improvements in public health and healthcare. However, as A.I. becomes integral to medical decision-making, ethical considerations must be addressed. Ensuring patient data privacy, fair A.I. practices, data security, transparency in A.I. operations, equitable access to A.I. tools and human oversight of A.I. decisions are essential. Continued advancements in A.I. for infection diagnosis promise even more effective disease treatments and prevention strategies in the future, all while ensuring that healthcare practices remain ethical and equitable.

DOI: 10.5281/zenodo.10952498

Introduction: Rheumatoid arthritis (RA) is a chronic multisystem disease of unknown cause. The characteristic feature of RA is persistent inflammatory synovitis usually involving the peripheral joints in a symmetric fashion. The hallmark of the disease is cartilage damage and bone destruction. The extra articular manifestations also depend upon the duration of the disease. If the duration is more the severity is also more. EAM are also associated with excessive mortality, since they affect major organs. The aim of the study is to identify and analyze the common presenting complaints of rheumatoid arthritis patients and to assess the various joint involvements and it’s relation with the duration of the disease and to assess advantageous effects of disease modifying anti rheumatic drugs. Materials and Methods: Patients with symptoms suggestive of Rheumatoid arthritis who represented Orthopedics OPD at Government Medical College hospital Krishnagiri for period of one year were included in this study. A total number of 100 patients who presented with typical clinical features based on the Modified American College of rheumatology criteria and already diagnosed to have RA were included in the study. Results: A total number of hundred patients were included in this study in the age group ranging from 18-74years. Fatigability, Loss of weight and Fever were observed in 91%, 41% & 52% of patients respectively. All patients showed involvement of PIP& MCP joints. The next common joint involved was wrist in 82% of patients extra articular manifestations (EAM) were found in 41%of patients studied. Among the EAM, anemia was the predominant manifestation and seen in 22% of patients. Majority of the patients with EAM were seropositive. And seropositive patients presented with joint damage earlier than seronegative patients. DMARD is required in 85% of patients to overcome the symptoms. Conclusion: Morbidity associated with RA remains highly prevalent. The disease has female preponderance with a significant proportion having positive family history. Most common joints involved are the MCP and the wrists and the most common deformity we found ulnar deviation of digits. There are significant proportions of patients who present with high disease activity. Anemia, thrombocytosis and extra articular manifestations are common. Most of the patients are on DMARDs with methotrexate being the most commonly used drug.

DOI: 10.5281/zenodo.10952517

Background: Chronic kidney disease (CKD) is a public health problem, with rising incidence of kidney failure, with poor outcome. Kidney injury molecule – 1 (KIM-1) is markedly induced in acute and chronic kidney disease. Aim: To determine the role of KIM – 1 in   assessing the severity of renal injury in renal transplant recipients. Methodology: A case control study included 45 individuals (group A) of both genders above 18 years with renal transplant recipients and 45 age and sex matched healthy subjects (group B) with normal renal function and no evidence of underlying illness as controls. In the KDIGO guidelines, based on the fluctuant serum creatinine level i.e., ≥ 0.3 mg/dL within 48 hours, the renal transplant recipients and controls were divided into those with kidney injury (≥ 0.3 mg/dL) and those without kidney injury (< 0.3 mg/dL). KIM – 1 was measured by sandwich ELISA method. Urinary KIM-1, Serum urea, creatinine, calcium, phosphate & spot urine protein creatinine ratio was analysed using spectro-photometric analysis. Serum triglycerides, HDL & total cholesterol were estimated using enzymatic colorimetric test. Result and Conclusion: The mean urine KIM – 1 level in renal transplant recipients with kidney injury is higher than levels in recipients and controls without kidney injury. When compared with serum creatinine and urea, KIM-1 is an early biomarker of kidney injury, which becomes obvious after the kidney damage is established. It facilitates early diagnosis of kidney injury and management strategies, thereby reducing the morbidity and mortality in renal transplant recipients.

DOI: 10.5281/zenodo.10952543

Gallbladder stones continue to be the leading cause of abdominal morbidity and affect a large portion of the population in many different countries across the world. The goal of this study was to determine the conversion rate and identify the factors responsible for conversion of laparoscopic cholecystectomy to open cholecystecto-my. Hence, these findings will allow us to improve patient safety by reducing time to conversion, better operat-ing room scheduling and efficiency, and more relevant and accurate preoperative counseling, it is necessary to determine a patient’s risk for conversion based on preoperative information. A hospital based cross sectional study was conducted in general surgery department, in Government Thanjavur medical College and Hospital. A total of 75 Patients presenting with symptomatic gall stone disease without choledocholithiasis between De-cember 2017 and October 2019 were included in the study. The present study of 75 patients has shown that gallstone diseases were more common in females than to males with a ratio of 2: (68 % females and 32% males). The most common age of presentation of gallstone diseases is 41-50 years (28% of the patients present-ed in this group). Most of the patients had right hypochondrium pain followed by vomiting (71%) and jaundice (4%) as the chief complaint. Ultrasonography is the most economical, simplest, easiest and an initial tool for the evaluation of gallstone diseases. Patients with thickened gallbladder wall had a higher rate of conversion i.e, 5 out of 13. This was one of the important parameter. Patients who presented on admission with acute cholecys-titis had a higher conversion rate to open procedure as compared to those who presented with only cholelithia-sis. The main cause for conversion from laparoscopic cholecystectomy to open procedure was difficulty in iden-tifying the anatomy of the Calot‟s triangle as a result of dense omental adhesion (83.3%) followed by common bile duct injury (16.7%). Laparoscopic cholecystectomy is a safe and reliable surgery. With growing experience by the surgeons in laparoscopic technique, complications and conversion rate can be brought down to a mini-mum.

DOI: 10.5281/zenodo.10952584

Background: It is crucial to understand the roles of enzymes in lipid metabolism and cardiovascular health due to the complex link between serum paraoxonase enzyme activity and dyslipidemia in obese people. Obesity is associated with dyslipidemia, a metabolic abnormality that greatly increases the risk of cardiovascular disease. Methods: From August 2023 through January 2024, prospective cohort research was carried out at the Bihta medical facility of the Employees’ State Insurance Corporation (ESIC). Nearly two hundred people with a body mass index (BMI) of 30 kg/m² or more, ranging in age from 18 to 65, were considered participants. Validated assays were used to quantify serum paraoxonase activity and lipid profiles. Standardized questionnaires were used to obtain demographic and lifestyle data. The link between serum paraoxonase activity and dyslipidemia markers was assessed statistically using Pearson correlation and multiple linear regression. Results: Among obese people, the study found that serum paraoxonase activity was negatively associated with the advancement of dyslipidemia over six months. The possible involvement of paraoxonase in the pathogenesis of dyslipidemia was demonstrated by the substantial correlation between decreases in paraoxonase activity and increases in LDL cholesterol and triglycerides. Conclusion: To control dyslipidemia and lower cardiovascular risk in obese people, the results stress the need to keep or increase serum paraoxonase activity. Potentially helpful in reducing dyslipidemia-related problems are lifestyle changes and targeted therapies that attempt to modulate paraoxonase activity. Recommendation: To better understand how paraoxonase activity relates to dyslipidemia in obesity, more studies are needed. Furthermore, it would be beneficial to investigate therapies that target paraoxonase activity to see if they can help prevent and manage cardiovascular disorders in people who are obese.

DOI: 10.5281/zenodo.10953373

Background: Dengue fever, transmitted by Aedes mosquitoes, poses a global health threat, with over 96 million symptomatic cases reported annually. Thrombocytopenia, a common haematological manifestation in dengue, can lead to severe complications. Grade 3 thrombocytopenia, with platelet counts below 50,000/mm³, signifies disease severity, warranting prompt intervention. While platelet transfusion is crucial, concerns with Random Donor Platelets (RDP) prompt exploration of Single Donor Platelets (SDP). This study aims to elucidate post-SDP transfusion platelet recovery dynamics in Grade 3 thrombocytopenic dengue patients. Methods: This prospective observational study spanned 5 months at a Tertiary Healthcare Centre in Eastern Uttar Pradesh, India, from August to December 2023. Patients aged ≥18 years with severe dengue and Grade 3 thrombocytopenia (<50,000/mm³) were recruited. Single Donor Platelet (SDP) was prepared using TRIMA ACCEL Automated Blood Collection System. Platelet counts were analyzed with the BC 6200 Auto haematology Analyzer. Data were recorded on MS Excel and analyzed using SPSS version 20.0. Results: A total of 73 Single Donor Platelet (SDP) transfusions were performed in 2023 at our centre, for Dengue patients. Notably, among Dengue patients from August to December 2023, 7 individuals required 2 SDP transfusions each, while 2 Dengue patients required 3 SDP transfusions each. The mean SDP yield ranged from 3.1 x10¹¹ to 6.0 x10¹¹, averaging 4.1 ± 0.7 x10¹¹. Demographic distribution showed 29 males (39.7%) and 44 females (60.3%), with a mean age of 39.6 ± 15.4 years. Platelet counts significantly increased post-transfusion: Pretransfusion (19.2 ± 6.6 x 10³ per cumm), Day 1 (50.7 ± 20.2 x 10³ per cumm), Day 2 (75.8 ± 27.8 x 10³ per cumm), and Day 3 (106.6 ± 29.4 x 10³ per cumm) (df=3, F=187.321, p=0.000). Conclusion: In conclusion, the findings of this study underscore the efficacy and safety of SDP transfusion in Grade 3 thrombocytopenic dengue patients, offering a promising therapeutic approach for mitigating bleeding risks and improving patient outcomes.

DOI: 10.5281/zenodo.10953426

Objectives: The present study was to evaluate the pattern of antihypertensive drugs prescription in hypertensive diabetes mellitus patients. Methods: A pre-tested interviewer-administered questionnaire was used. Patients with diabetes were identified by reviewing the physician’s diagnosis on their chart/medical record. After a 15-min rest, (SBP and DBP) were measured twice at 3-min intervals in the sitting posture, and the mean was calculated. Hypertensive individuals had SBP and/or DBP of 140/90 mmHg or higher, respectively, or were on antihypertensive treatment. FBS levels were measured using blood samples (3 ml) obtained after overnight fasting of 8–12 h. The glucose GOD POD Methods was used to evaluate plasma glucose through a fully autoanalyzer. Results: A total of 600 hypertensive diabetes patients with age group 20 to >60 years were enrolled. Most of the patients 220(36.67%) were in age group of 51-60 years. Most of the patients 326(54.33%) were females. Calcium channel blocker (CCB) was prescribed to most of the 284(47.34%) hypertensive patients. Angiotensin receptor blockers (ARB) was prescribed to 218(36.33%) hypertensive patients. Metformin 488(81.33%) and Sulfonylureas 356(59.33%) were prescribed to most of the diabetic patients. Telmisartan 143(31.49%) and amlodipine 126(27.75%) were prescribed in most of the hypertensive patients as a monotherapy. Telmisartan with amlodipine were prescribed as a combination therapy in most of the hypertensive diabetic patients. Conclusions: Hypertension with diabetes is more preponderance in old age female population. Calcium channel blocker (CCB) and angiotensin receptor blockers (ARB) are the most common prescribing antihypertensive drugs. Metformin and sulfonyl ureas are the most common prescribing antidiabetic drugs. Telmisartan and amlodipine are the most common drugs used as monotherapy. Most common drugs used as a combination therapy are telmisartan with amlodipine in hypertensive diabetic patients.

DOI: 10.5281/zenodo.10953494

Background: Diffusion-weighted magnetic resonance imaging (DW-MRI) is a promising non-invasive method for diagnosing acute ureteral blockage. Since water molecules diffuse into tissues, DW-MRI provides detailed images of physiological and pathological conditions in a safer way than previous imaging approaches. Methods: A prospective observational research from June 2023 to February 2024 examined DW-MRI’s acute ureteral blockage detection accuracy. 120 consecutive individuals with ureteral blockage symptoms were recruited. Within 48 hours of presentation, 1.5T DW-MRI scans were performed. Sensitivity, specificity, PPV, and NPV assessed diagnostic accuracy. Results: DW-MRI diagnosed acute ureteral blockage with 94% sensitivity and 90% specificity. Both PPV and NPV were 92% and 93%. DW-MRI was more accurate than ultrasonography and CT scans, but less sensitive. Diagnostic time with DW-MRI was 1 hour, much faster than CT scans. No DW-MRI side effects were recorded. Conclusion: DW-MRI proves to be an effective and reliable non-invasive method for diagnosing acute ureteral obstruction. Its high diagnostic accuracy, rapid turnaround time, and safety profile make it a valuable tool in clinical practice. Integration of DW-MRI into routine diagnostic protocols is recommended to expedite diagnosis and improve patient care. Recommendation: Clinicians should consider DW-MRI as the initial imaging modality for patients presenting with symptoms suggestive of ureteral obstruction. Further research is warranted to explore DW-MRI’s cost-effectiveness and long-term outcomes, ensuring its optimal utilization in clinical settings.

DOI: 10.5281/zenodo.10953525

Introduction: Iron deficiency anaemia is the most common cause of anaemia in developing countries. Oral iron preparations have limitations in their use. Treatment of iron deficiency is essential to prevent complications. Parenteral iron preparations overcome these limitations and can be used in treatment of anaemia. Objective: To study the effectiveness and safety of ferric carboxymaltose in treatment of anaemia in pregnancy. Method: Pregnant women between 28 to 36 weeks of gestation, with moderate anaemia (Hb 7.1 – 10g/dl) were included in the study. Iron deficiency anaemia was confirmed by complete haemogram, serum iron indices and peripheral smear.  Women who were intolerant, non-compliant or not responding to oral iron therapy were included in the study. Women with history of previous parenteral iron infusion, blood transfusion, adverse reactions to iron preparations, anaemia due to other causes except iron deficiency anaemia, chronic infections and chronic medical diseases were excluded from the study. 1000mg of FCM infusion was given under supervision to all women. Blood indices were rechecked at 2 week and 4 weeks interval after FCM administration. Results were tabulated. Results: Total 64 women completed the study. Mean Hb before FCM administration was 8.2g/dl and mean ferritin level was 40.2 ng/ml.  Mean Hb observed after 2 and 4 week of administration of FCM was 9.6gm/dl and 11.2gm/dl respectively (p<0.001) and mean increase in Hb observed 2 and 4 weeks was 1.1gm/dl and 2.9gm/dl respectively (p<0.001). 20% had mild adverse effects; most of them were self-limiting and managed conservatively. Conclusion: Ferric carboxymaltose was found to be safe and effective in treatment of iron deficiency anaemia in pregnancy with moderate anaemia.

DOI: 10.5281/zenodo.10953550

Introduction: This prospective study aimed to conduct a comparative analysis of visual outcomes and complications associated with two intraocular lens (IOL) fixation techniques: iris claw IOL and scleral fixation IOL. The primary objective was to evaluate changes in best-corrected visual acuity (BCVA), intraocular pressure (IOP), and the occurrence of early and late post-operative complications in patients undergoing these procedures. Material and Methods: A total of 60 eyes from 60 patients were included in the study, with 30 eyes receiving iris claw lenses (Group A) and 30 undergoing scleral fixation IOL (Group B). Comprehensive pre-operative and post-operative assessments, including BCVA, slit lamp examinations, and IOP measurements, were conducted on postoperative days 1, 4th week, and 12th week. Results: In our study involving 60 eyes, iris claw lenses showed superior visual outcomes compared to scleral fixation IOL. The iris claw group exhibited better uncorrected and corrected visual acuity. Notably, scleral fixation IOL led to a significant increase in intraocular pressure at various postoperative intervals. Early complications such as anterior chamber reactions and pupil distortions were more frequent in the iris claw group. Late complications, including IOL decentration and tilt, cystoid macular edema, and retinal detachments, were more prevalent in the scleral fixation group. Conclusion: The study reveals a trade-off between iris claw IOL and scleral fixation IOL. Iris claw IOL offers improved visual acuity but comes with a higher risk of early complications. On the other hand, scleral fixation IOL is linked to elevated IOP and a greater likelihood of late complications.

DOI: 10.5281/zenodo.10955329

Introduction: Anemia is a condition in which the number of red blood cells or the hemoglobin concentration within them is lower than normal. The most common nutritional cause of anemia is iron deficiency, although deficiencies in folate, vitamins B12 are also important causes. Aims: To find out the compliance and impact of oral iron therapy in nutritional deficiencies anemia among females attending outpatient department. Material and Methods:  A prospective observational study was conducted to assess the compliance and impact of oral iron therapy. Females who were diagnosed with anemia on complete blood count with microcytosis were included. Results: Total 421 patients were enrolled in study. Out it 91 (21.61%) were suffering from moderate anemia and 330 (78.39%) from mild anemia. 276 patient (65.56 %) were fully complied and 145 (34.44 %) were partially complied. 349 patients (82.89%) achieved normal hemoglobin levels after end of study period.  Conclusions: Oral iron therapy is effective tool to improve the health status of women and to decrease the sufferings. Compliance need to be improved by educating and raising awareness about anemia and easy treatment options.

DOI: 10.5281/zenodo.10955401

Background: Visakhapatnam, a rapidly industrialising city in Andhra Pradesh, India, provides a unique setting for investigating the impact of environmental contaminants on health due to its diversified industrial activities, which include substantial port operations, steel industry, and heavy traffic congestion. The aim of this study is to determine the relationship between exposure to environmental contaminants and the prevalence of contact dermatitis in the local community. Methods: A prospective cohort study enlisted 100 participants from Visakhapatnam’s urban and semi-urban districts, with a balanced gender distribution and a wide age range (18-65 years). Based on the distance between residential areas and industrial zones as well as occupational exposure, three levels of exposure to environmental contaminants were classified: low, moderate, and high. The incidence of contact dermatitis was tracked over a 6-month period, with specific pollutants such as port-related emissions, steel factory emissions, and traffic emissions analysed for their relative risk (RR). Results: 42 individuals from the group experienced contact dermatitis, indicating a significant correlation with the amount of pollution they were exposed to (Chi-square test, p < 0.05). A 73.3% incidence rate was associated with high exposure. High exposure was verified by multivariate logistic regression as a significant, independent predictor of contact dermatitis (adjusted odds ratio [aOR] = 3.5; 95% CI: 2.0-6.1), after local factors were taken into account. Conclusion: The study found a high link between ambient pollutant exposure and the prevalence of contact dermatitis in Visakhapatnam. It emphasises the necessity of focused measures to lower exposure to particular pollutants, especially in regions with a high concentration of industry and congested roads.

DOI: 10.5281/zenodo.10955422

Aim and Objective: An unparalleled mucormycosis outbreak occurred following the second wave of COVID-19 in 2021. In particular, among individuals with uncontrolled Diabetes Mellitus (DM), the Rhino-Orbital-Cerebral Mucormycosis (ROCM) has evolved into a critical medical issue. ROCM is a rare infection associated with the angiotropic fungus, resulting in significant morbidity and mortality regardless of medical care. The aim of the study is to determine the incidence of ROCM and its contributing factors in the midfacial region. Materials and Methods: A descriptive study was conducted in the Department of Dental Surgery, CMCH, Coimbatore, from May 2021 to May 2022. 154 cases of mucormycosis with midface involvement were included in the study, and various clinical, radiographical, and demographic analyses were carried out.  The COVID status, vaccination status, and co-morbidities of COVID infection with mucormycosis were also assessed. Results: The findings revealed that mucormycosis was prevalent in male patients with positive COVID status. Diabetic individuals exhibited a higher incidence of mucormycosis, with ROCM affecting mostly the left-side sinuses of the face. There was no significant difference in data on place of residence, steam inhalation, and oxygen usage throughout the illness. Co-morbidities besides Diabetes Mellitus showed no significant effect on individuals with mucormycosis. Conclusion: Mucormycosis is a devastating opportunistic illness that necessitates prompt detection and treatment. Compared to those who are non-diabetic and were recently diagnosed with DM, COVID patients with DM showed a greater incidence of ROCM. Despite extensive medical management and surgical interventions, poor glycemic levels are associated with unfavorable outcomes.

DOI: 10.5281/zenodo.10955441

Background: This study aimed to assess the language delay in 9 month to 3 years old children with ITS and pre ITS at the time of diagnosis and the effect of treatment on speech and language development after 6 months to one year. Methodology: The study was conducted as a  prospective longitudinal observational study on children of age 9 month to 3 year with diagnosis of ITS and PRE ITS admitted in Department of Pediatrics, Kamla Nehru Hospital and Hamidia Hospital Bhopal during the study period of 21 months. All the children were assessed for presence of development delay according to development quotient and assessment of language delay was done using Language Evaluation Scale Trivandrum (LEST 0-3 years). Results: Mean age of children enrolled in our study was 12.91±4.66 months and males slightly outnumbered females in our study with male: female ratio of 1.15:1 in children with preITS as well as ITS. At baseline, i.e. before initiating treatment, no language delay was noted in only 5 (5.8%) cases, whereas majority of children had 2 item delay (53.5%), followed by 23.3% and 17.4% children with 3 items and 1 item delay respectively. At baseline 5 patients had no delay whereas at final follow up 6 of patients had no delay. The LEST positive at baseline were observed in 76.7% cases which at follow up was documented in significantly lower proportions of children with preITS and ITS (57%; p<0.05). After recovery from illness, the improvement was observed in 42 out of 86 children. The therapy was constituted of diet, medication, stimulation and on multivariate analysis, injection trineurosol and calorie addition with injection trineurosol were found to be independent factors associated with recovery. Conclusions: ITS and PreITS are associated with language delay in as high as 76.7% cases. Early identification and management of ITS and preITS may improve the language development in such children. Further studies are warranted to explore the speech and language delay in children with ITS and preITS.

DOI: 10.5281/zenodo.10955463

Background: Chronic alcohol consumption affect most of the organs in the body, dose related damage to liver cause alcoholic liver disease. Alcoholic liver disease is a major cause of alcohol related morbidity and mortality. The general marker of alcoholic liver disease used in practice are Aspartate transaminase(AST), Alanine transaminase(ALT), Gamma glutamyltransferase (GGT), some newer markers are carbohydrate deficient transferrin, Mitochondrial AST (m- AST), Glutathione-s-transferase. Mitochondrial AST (m- AST) is an isoenzyme of AST found in mitochondria. In excess alcohol drinking there is an increased expression of this enzyme in the plasma membrane of hepatocytes; following cell necrosis its serum level is elevated. So m-AST in combination with other markers can be used to detect alcoholic liver disease. Objectives: The objective is to study the activity of serum Mitochondrial Aspartate Transaminase (m-AST) in alcoholic liver disease and compare the results with that of healthy individuals and to calculate m-AST/ total AST ratio. Then find its use as a marker for alcoholic liver disease. Materials and Methods: This case-control study conducted in our tertiary health care center included 40 healthy volunteers who served as control and 40 cases of alcoholic hepatitis (group I) and 40 cases of alcoholic cirrhosis (group II). The blood samples were analyzed for Serum Mitochondrial Aspartate Transaminase (m- AST), Serum GGT, Serum AST, Serum ALT, Serum Total Bilirubin, Serum Albumin and m-AST/ total AST ratio is calculated. Results: In this study serum m-AST levels were significantly elevated in group I (19.05±1.60 ) with p< 0.0001 and group II (13.18±1.17) with p< 0.0001,with respect to controls (2.06±0.13). m-AST/t-AST ratio is increased in group I (18.35±0.52) and group II (18.93±0.53) in comparison to controls(8.28±0.8).The elevated serum m- AST levels seen in group I and group II shows positive correlation with serum GGT values within the group. The Pearson’s correlation value obtained in group I (r +0.759) and group II (r+0.8480). Serum GGT is a known marker of alcoholism. Conclusion: The study shows that m-AST and m-AST/t-AST ratio is elevated in alcoholic liver disease and it correlates with serum GGT a marker of alcoholism. Hence Mitochondrial AST can be used as a marker for chronic alcoholism in combination with other markers.

DOI: 10.5281/zenodo.10955524

Globally, tuberculosis (TB) remains a major public health problem and ranks second among the leading causes of death due to infectious disease. The mechanisms provided for notification include both paper and case-based web based online reporting system called NIKSHAY. However, the notification by private providers has been very low. To determine the awareness and practice related to TB notification among private health care providers in Shikaripura, Shivamogga Karnataka. It was a Cross sectional study conducted over a period of 2 month. For this study three groups of private health care providers was covered in Shikaripura Taluk – which includes private medical practitioners, pharmacists and lab technicians. Out of 145 respondents, majority of the respondents were Male (92.4%) and 55.1% were aged less than 45 years. 76.5% respondents were aware that TB is a notifiable disease .Only 35(24%) had registered in NIKSHAY and only 11 (out of 35) (31.4%) had notified in NIKASHAY once. The programme should develop innovative strategies that provide enablers, address concerns of practitioners while having simple mechanisms for TB notification.

DOI: 10.5281/zenodo.10955757

Background and Aim: No optimal treatment has been found yet for freezing-phase frozen shoulder to quickly alleviate pain and enhance joint mobility. This study aims to compare the outcomes of Hydrodilatation technique with intra-articular corticosteroid injections on range of motion and pain at 1 month and 1 year. Material and Methods: The study involved 50 patients who were randomly assigned to be evenly distributed among the two study groups. Normal saline, Iohexol dye, a 22 G spinal needle, and a 10 ml syringe were utilized for the hydrodilatation procedure. During the procedure, 2 ml of Triamcelone acetate (80 mg), 2 ml of 2% lignocaine, and a 22 G spinal needle were utilised. The patient undergoes assessment following a thorough history, examination, and investigation to determine the appropriate procedure, such as hydrodilatation or corticosteroid injection. The SPADI and ASES Score have been computed. Results: The majority of patients fall within the 40-50 age bracket. 31 individuals are male, making up 62% of the group, while 19 individuals are female, accounting for 38%. Within the Corticosteroids group, the initial mean abduction was just 21%, but increased to 61%. Similarly, external rotation in a neutral position started at 18% and rose to 89%, while external rotation in abduction began at 20% and improved to 83% after 1 year. After hydrodilatation, the SPADI score improved from 113 to 36 at 1-year follow-up, whereas in the corticosteroid group, the SPADI score improved from 112 to 34 at 1-year follow-up. After 1 year, the ASES score was 86 in the hydrodilatation group and 87 in the corticosteroid group. Conclusion: The shoulder of the dominant hand (right side) is frequently affected. There was no notable variation in the results when evaluated with SPADI and ASES between the two groups after 1 month, 6 months, and 1 year of follow-up.

DOI: 10.5281/zenodo.10955783

Objective: To study the outcomes of buccal mucosal graft urethroplasty in anterior urethral strictures in a tertiary care centre. Materials and Methods: A prospective observational study was performed in patients undergoing urethroplasty in Madurai medical college in the Department of Urology for a period of one year (2022-2023). Patients with anterior urethral stricture planned for non-transecting dorsolateral (one-sided) augmentation urethroplasty using BMG were included in this study. All the cases were operated by a team of urologists. The intraoperative findings, type of graft used and outcomes of surgical intervention were observed. Results: With urethroplasty, surgical reconstruction has higher long-term success rates; most studies report success rates between 85 and 90 percent. Various methods have been employed for urethroplasty, contingent on the stricture’s kind, length, and location. The commonest cause of stricture in our study is iatrogenic (40%) followed by trauma (25%) and the commonest site of urethral stricture is penile urethra. The success rate in our study is 66 to 88 % which is on par with the literature.

DOI: 10.5281/zenodo.10955807

Background: Blood transfusion has an important role in the modern practice of medicine and has undoubted benefits but some adverse effects do occur despite all relevant laboratory tests.  Access to adequate and safe blood transfusion facilities is an integral part of any basic health care service; they are often lifesaving in critically ill patients. Any unfavorable transfusion-related event occurring in a patient during or after the transfusion of blood and blood components is known as a transfusion reaction (TR). Objective: Present study aim to investigate the adverse events of transfusion in a tertiary health care centre. Material and Methods: This were a retrospective study which included all transfusion reactions reported to the blood bank from clinical departments within the period of May 2018 to May 2023 at a tertiary care centre.  These reactions were investigated and classified using the Institute’s protocol. Result: In our study, a total 13837 number of blood units were issued and 24 transfusion reactions were reported to the blood bank during the study duration. Febrile non-hemolytic transfusion reactions (FNHTR) were the most common followed by allergic reactions. Conclusion: During transfusion patient should be closely monitored and in case of an undesirable event, it should be reported to a blood bank. To minimize the risk of transfusion reaction leucofilters or leucocyte-depleted blood products should be advised, especially in cases of multiple transfusions.

DOI: 10.5281/zenodo.10955825

Introduction: Post-Traumatic stress disorder in patients admitted in Medical Intensive Care UNIT-A Prospective study. One-fifth of critical illness survivors have clinically relevant PTSD symptoms in the year after intensive care. Methodology: All consecutive patients admitted to the Medical Intensive Care Unit(MICU) in Christian Medical College Vellore, during the study period march 2010 to October 2010, between 18 to 65 years who had completed minimum 24 hours on mechanical ventilation, were included in the study. Patients too ill to give consent and with memory impairment and in delirium were excluded. Patients were interviewed at time points, first 4-14 days after extubation form mechanical ventilation and second 2 months after discharge from hospital. The interview at 2 months was on telephone. The UK -Post traumatic stress syndrome (PTSS) 14-question inventory was used to assess PTSD. 140 were able to be taken for study and 92 patients followed up the at 2 months. Results: The prevalence of PTSD at baseline is 32.8% and at 2 months is 23.9%. The Fisher Exact test is significant. Past history of Psychiatric illness and diagnosis of poisoning were associated with development of PTSD. The Patients who had PTSD at baseline continued to have symptoms at two months and patients who had PTSD at baseline continued to improve. Discussion: The prevalence of PTSD is patients who were discharged from Medical intensive care is high. Early recognition and treatment will reduce the morbidity.

DOI: 10.5281/zenodo.10955834

Background: Leiomyomas of the uterus are extremely common neoplasms. Symptomatic leiomyoma need urgent attention by myomectomy in younger females whereas hysterectomy still remains the traditional modality of treatment. The aim of this study is to evaluate Based on this aim of our study is to study the gross and histomorphological pattern of the lesions and also to correlate the pattern of Leiomyoma with clinical presentation. Material and Methods: A total of 1200 hysterectomy specimens diagnosed clinically as uterine leiomyoma’s that were received in Department of Pathology. This data is from past 25 years. Hysterectomy specimens with other female genital tract conditions were excluded. The study was a retrospective study. The relevant clinical data were retrieved from histopathological requisition forms and clinical records. Result: Most common symptom was menstrual disturbances. In the present study, 61% of the patients presented with menstrual disturbances of which Menorrhagia was the most common symptom. In majority of the cases with submucosal fibroids Dysfunctional uterine bleeding ranging from menorrhagia to metrorrhagia, polymenorrhoea and polymenorrhagia were seen.  Intramural fibroids on the other hand presented with mass abdomen, pain abdomen along with menstrual disturbances. In present study, 328 leiomyomas (27.3%) showed degenerative changes and Hyaline change was the most common change observed. In this study 26 cases (2.2%) were variants of Leiomyoma of which the most common variant was Cellular type (20 cases, 1.7%), followed by Lipoleiomyoma (3 cases, 0.25%) and one case each in Symplastic (0.08%), Vascular (0.08%), Leiomyoma luteum (0.08%). Conclusion: If uterine leiomyomas were detected in time and properly managed, extensive and complicated procedures and their adverse consequences could well be avoided. The present study provides data regarding the histological patterns of myometrial lesions in hysterectomy specimens. It is mandatory that all hysterectomy specimens must be evaluated by histopathological examination for better postoperative medical and surgical treatment of the patients.

DOI: 10.5281/zenodo.10955878

Interstitial lung disease refers to a diverse group of over 100 different lung diseases that are often grouped by clinical, radiological and Pathological features. As there are 200 distinct subtypes of ILD, physicians may find it difficult to make an appropriate diagnosis A thorough medical testing, physical examination, review of laboratory data, physical examination, radiography, is needed in certain cases lung biopsy is needed. A multi-disciplinary review is a key element of the process that may have a big influence on diagnosis and treatment. As these illnesses have similar clinical presentation plain radiograph of chest remains the corner stone of basic imaging in ILDS. HRCT is more sensitive than chest radiograph and can reveal problems earlier. HRCT can often reveal structural abnormalities in the lungs in people with normal chest x ray because 10-25% of the patients with ILDS have a normal HRCT. This study compares clinical conventional chest radiography and HRCT findings in the assessment of ILDS.

DOI: 10.5281/zenodo.10955894

Background: Antimicrobial resistance among Escherichia coli causing urinary tract infection (UTI) is a public health concern. Objectives: 1. To find the prevalence of E. coli causing urinary tract infections from urine samples and to determine the antimicrobial susceptibility pattern of E. coli isolates by Kirby Bauer’s disc diffusion method. 2. To study about the minimum inhibitory concentration (MIC) fluoroquinolone resistant E. coli isolates by Microbroth dilution method. Method: The Prospective study was conducted among 150 UTI Patients attending Tertiary care centre for treatment. Ethical principles were adhered. Their socio – demographic details were collected and received urine samples were processed using standard methods and antibiotic susceptibility was done by Kirby-Bauer disk diffusion test and minimum inhibitory concentration of fluoroquinolone resistant E. coli isolates by Microbroth dilution method. Data was analysed using SPSS Software version 23.0. Results: The mean age of the participants was 48.55 + 14.37. Females were predominant. Majority, 49.3% belonged to 31-60 years age group. Among the 241 isolated organisms from culture, the most common were E. coli 62.2% (150) and Klebsiella pneumoniae was found to be 10.4% (25) of the participants and candida was found in 6.5%. Highest resistance rate of E. coli growth was found in Co-trimoxazole (81%), Nalidixic acid (80 %), Ampicillin (78%), Ciprofloxacin (70%) and levofloxacin (60%). It was found 32.26% of participants who are having Levofloxacin-resistant Escherichia coli with 32µg/ml Minimum Inhibitory concentration (MIC). 40.91% of participants showed Ciprofloxacin resistant Escherichia coli with 64µg/ml MIC. Conclusion: In the present study, 62.2% of E.coli growth in their culture who was complained as urinary tract infection. The empirical guidelines of UTI treatments and prophylactics that are optimized against uropathogens without altering the normal development of microflora.

DOI: 10.5281/zenodo.10955910

Objective: According to the ‘‘vascular’’ theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. Hemorrhoid laser procedure (LHP) is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by laser coagulation. Aim: Our aim was to compare the hemorrhoid laser procedure with stapler haemmorhoidopexy procedure for outpatient treatment of symptomatic hemorrhoids. Material and Method: A comparison trial between hemorrhoid laser procedure or stapler haemmorhoidopexy was made. This study was conducted at Department of General Surgery, Al Azhar Medical College Thodupuzha. Patients with symptomatic grade III or grade IV hemorrhoids with minimal or complete mucosal prolapse were eligible for the study: 40 patients treated with the laser hemorrhoidoplasty, and 40 patients–with open surgery hemorrhoidectomy. Operative time and postoperative pain with visual analog scale were evaluated. Results: A total number of 40 patients (23 men and 17 women, mean age, 46 years) entered the trial. Significant differences between laser hemorrhoidoplasty and stapler procedure were observed in operative time and early postoperative pain. There was a statistically significant difference between the two groups regarding the early postoperative period: 1 week, 2 weeks, 3 weeks and 1 month after respective procedure (p<0.01). The procedure time for LHP was 15.94 min vs. 26.76 min for stapler surgery (p<0.01). Conclusion: The laser hemorrhoidoplasty procedure was more effective than stapler surgical hemorrhoidectomy. Postoperative pain and duration time are only two indicators for this difference between there procedures.

DOI: 10.5281/zenodo.10955928

Background and Aim: Spacing pregnancies more than 2 years apart can prevent nearly one third of maternal deaths and 10% of child mortality. Postpartum contraception options include lactational amenorrhea, barrier methods, progesterone-only pills, sterilization, and IUCDs.The current study aimed to assess the percentage of women who agree to PPIUCD insertion and to examine the factors linked to the acceptance of PPIUCD insertion based on their socio-demographic and obstetric characteristics, as well as future pregnancy intentions. Material and Methods: The study involved 200 women who underwent Postpartum Intrauterine Contraceptive Device insertion (PPIUCD), received counselling, provided written consent, and met specific inclusion and exclusion criteria. The recorded data was compiled and entered in a spreadsheet computer program (Microsoft Excel 2007) and then exported to data editor page of SPSS version 15 (SPSS Inc., Chicago, Illinois, USA). Results: PPIUCD insertion was 5.5% among total deliveries in study period.Majority of women (86.5%) belonged to age group 20-29 years. Acceptance of PPIUCD was high (54%) in case of 2nd para women and most of them (90.5%) were housewives.54.5% of PPIUCD insertion were done intra-operatively during caesarean section and 23.5% of PPIUCD insertion were done immediately after vaginal delivery. 22% of PPIUCD insertion done within 48 hours of vaginal delivery. Conclusion: PPIUCD is a safe, highly effective and reliable method of contraception with various benefits such as easy insertion, minimal adverse impact on breastfeeding, cost-effectiveness, relief of over-crowded outpatient facilities, and protection against unwanted pregnancy and abortions. Utilization of PPIUCD in the Post-Partum Family Planning Methods shows great potential.

DOI: 10.5281/zenodo.10955947

Background: In present day anesthesia practice various drugs has been used for a better somatic and visceral analgesia as adjuvants along with local anesthetic drug given in spinal anesthesia. Aim: The main aim of the study was to compare efficacy, safety, hemodynamic stability and analgesic effect of intrathecal dexmedetomidine and fentanyl as adjuvants to hyperbaric 0.5% bupivacaine in lower limb Ilizarov surgeries. Materials and Methods: Study was done taking 60 no. of patients who were classified under American society of Anesthesiologists classes I, II & III posted for lower limb ilizarov surgeries. Patients were randomly allocated using sealed envelopes into two groups. Group I-Given 15mg hyperbaric bupivacaine +5µg dexmedetomidine, group II-15mg hyperbaric bupivacaine +25µg fentanyl intrathecally. Results: In patients who have received dexmedetomidine observed to have significantly longer analgesic effect than the other group who received fentanyl as adjuvant. Meantime taken for sensory regression to S1 were 160 ±22.7 in group I and 110±20.5 in group II. Time taken for regression of motor block to Bromage scale 0 was 350±22.3 in group I and 277±17.9 in group II. Conclusion: Intrathecal administration of dexmedetomidine as adjuvant is associated with prolonged analgesic effect, hemodynamic stability and minimal requirement of rescue analgesia as compared to fentanyl.

DOI: 10.5281/zenodo.10955966

Background: Over the past decade, social networking has become a vital medium for healthcare professionals (HCPs) in Chennai, Tamil Nadu, facilitating the sharing of awareness, information exchange, and interpersonal connections. However, uncertainties persist regarding the fundamental behaviours of HCPs and the ethical use of social media to enhance efficiency within the healthcare system. This study aims to explore HCPs’ attitudes towards the professional use of social media in Chennai. Methods: A cross-sectional study involving 460 HCPs from diverse healthcare professions in Chennai was conducted. Data were collected through a Google survey distributed via Google Forms. Descriptive statistics were employed for result analysis. Results: The study revealed a predominance of female participants, with the 25-35 age group being the most represented. Government-affiliated HCPs outnumbered those from the private sector. WhatsApp and Facebook emerged as the most commonly used social media platforms, with YouTube also being prevalent. Notably, participants largely concurred that social media, particularly Google, improved their knowledge and skills. Conclusion: The findings underscored that a significant proportion of respondents believed social media, specifically platforms like Google and WhatsApp, contributed to enhancing their knowledge and skills. Healthcare practitioners actively engage with social media, viewing it as an effective educational tool in the healthcare domain. These insights can inform strategies for the ethical use of social media in professional development among healthcare professionals in the region.

DOI: 10.5281/zenodo.10955982

Introduction: In the current HIV/AIDS era, understanding the mode of infection and its impact on individuals’ lives, particularly among security and sanitary workers in tertiary care hospitals, is imperative. This study aims to assess the socio-demographic profile and knowledge of HIV transmission modes in workers, along with the preventive measures they follow during their hospital duties. Materials and Method: A cross-sectional hospital-based study was conducted among all available sanitary (301) and security staff (148) at KGH/AMC, Visakhapatnam. Results: Indicate that the majority (96.3%) of participants are aware of AIDS as a lethal disease, and most (86.5%) perceive HIV as more contagious than HBV. While 81.4% are unaware of asymptomatic HIV-positive individuals, all recognize unprotected intercourse as a transmission route. However, awareness of mother-to-child transmission (84.8%) and transfer via blood products (59.1%) is quite poor. Only 62.2% of participants believe HIV is a significant public health issue, yet all agree that HIV screening for hospitalized patients is necessary. On the other hand, social engagements such as dining with HIV/AIDS patients are often denied (86.1%), indicating stigma. Nonetheless, the majority (99.3%) have a positive attitude and a desire to learn more about HIV/AIDS. Conclusion: This study emphasizes the importance of targeted education and awareness efforts to bridge knowledge gaps and reduce stigma among sanitary and security staff in healthcare settings.

DOI: 10.5281/zenodo.10956028

Septic embolism is an obstruction of a blood vessel, typically by an infected thrombus that travels through the bloodstream from a distant infectious source and blocks a blood vessel. Here a case is presented of pulmonary septic emboli in a middle aged patient who complains of fever, chest pain, vomiting and shortness of breath. He was diagnosed with massive pericardial effusion along with right atrial thrombus and multiple pulmonary emboli. On pericardiocentesis, reports were in favour of tuberculosis along with pyogenic features. Further investigations revealed presence of multiple septic / thrombotic embolus. Patient had septicemia which resolved slowly.

DOI: 10.5281/zenodo.10956240

Introduction: Low Back Pain (LBP) is one of the most common musculoskeletal problem. LBP is no longer the disease of adult and 39.8% of adolescent population is also found to suffer from LBP. Medical students are no exception to this health issue and study should be done in medical students to find out possible risk factors and their correlation to LBP. Method and Material: A cross sectional observational study was conducted in 146 under graduate students for the prevalence and risk factors of LBP. A self-made questionnaire was administered to the volunteers including demographic, anthropometric, hours of study, physical activity, etc. In the subject who reported LBP in past 4 weeks, the modified Oswestry LBP disability questionnaire was administered for assessing the disability in day to day activities. SF8 questionnaire for assessment of quality of life was administered to all medical students. Rating of pain was done using Numeric Rating Scale (NRS). Results: It was found that there was significantly higher LBP in underweight and overweight males as compared to normal BMI individuals. There is no statistically significant association in LBP and W/H ratio. Prevalence of LBP was higher in students whose self-study hours were higher. Students who were physically active had less prevalence of LBP. Prevalence of LBP had no changes as compared to duration of clinical posting. 83.6% had mild, dull aching pain and remaining 16.4% had moderate pain in severity. None had severe intensity of pain. LBP was cause of mild disability for 1.6% student, moderate disability for 85.24% and severe disability for 13.11% students. Discussion: Prevalence of LBP in undergraduate medical students in AIIMS Jodhpur is 41% which is quite high. It was found that less physical activity, bad posture and altered BMI in males were possible risk factors for this high prevalence. These are modifiable risk factors and hence can be prevented. There is a need of back schools and promoting education regarding proper posture, increased physical activity, recreational activities, exercises and stress free environment.

DOI: 10.5281/zenodo.10956517

Introduction: Antinuclear antibodies (ANA) are a group of antibodies that bind to components of the nucleus. ANA is the telltale sign of systemic autoimmune disease and thus can be used as a screening tool for autoimmune disease. Methodology: A prospective observational study was conducted at a tertiary care hospital from January 2019 to December 2019. This study aimed to evaluate the clinical presentation of patients with positive antinuclear antibodies. A hundred symptomatic patients with ANA-positive were selected for the study after institutional ethics committee clearance. Result: Out of 100 patients, 83% were female and 17% were male. The most common clinical manifestations in this study were fever (72%), Anemia (63%), Joint pain (53%), Skin Rash (32%), Oral ulcer (24%), Thrombocytopenia and Renal involvement (23%). Conclusion: Autoimmune disease should be suspected in patients presenting with fever, anaemia and joint pain, particularly in female patients of age groups 20-40 years. In this study female to male ratio was 8:1. For the confirmation and categorizing of disease the Extractable nuclear antibody ENA test should be advised for better patient care. Among the specific diagnoses after the ENA test, the most common connective tissue disorder was SLE (53.9%).

DOI: 10.5281/zenodo.10956583

Background: Lung cancer is one of the most common malignancies with high mortality, 13% of all new cancer cases and 19% of cancer related deaths worldwide are due to lung cancer. A 6.9% of all new cancer cases and 9.3% of all cancer related deaths in India are due to lung cancer. Materials and Method: This is a 1 year descriptive from January 2023 to December 2023 conducted in the department of pathology.30 cases were included in the study. Bronchial wash, bronchial brushing and cell block were obtained. Result: In our study of the total 30 cases, adenocarcinoma was the most common lung cancer followed by squamous cell carcinoma (SCC) and Small cell carcinoma. Conclusion: Bronchial wash, brush cytology with cell block are an important basic diagnostic tool in the diagnosis of lung cancers. This technique can be used concurrently with bronchial biopsy whenever required.

DOI: 10.5281/zenodo.10956597

Introduction: Preterm premature rupture of membranes (PPROM) poses a significant challenge in obstetrics, contributing to adverse fetomaternal outcomes. This study aimed to evaluate fetomaternal outcomes in late preterm PPROM cases at Jehangir Hospital, Pune, and Maharashtra. Methods: A prospective observational study was conducted from January 2016 to September 2017, focusing on singleton pregnancies experiencing PPROM between 34-37 weeks of gestation. Maternal history, clinical examinations, and relevant investigations were conducted. Maternal outcomes included mode of delivery, febrile morbidity, and postpartum complications, while neonatal outcomes comprised birth weight, Apgar scores, and NICU admissions. Results: Among 1735 deliveries, 59 (3.4%) were diagnosed with PPROM. Majority were primigravida (59.3%), with maternal age predominantly between 19-34 years. Notably, 39% had no identifiable risk factors for PPROM. Maternal complications were infrequent, with no instances of chorioamnionitis observed. Most neonates had birth weights between 2-2.5 kg, and Apgar scores varied with gestational age, with lower scores noted in earlier gestational ages. NICU admission rates were higher in the 34-34+6 weeks group. Conclusion: The study highlights the significance of maternal age and risk factor identification in PPROM cases. Understanding these factors aids in clinical management and improves outcomes. Regular antenatal and intrapartum monitoring are crucial in managing this common pregnancy complication. Recommendations: Comprehensive assessment of fetomaternal outcomes in late preterm PPROM cases provides insights into effective obstetrical management strategies. Identifying risk factors and optimizing care protocols can mitigate adverse outcomes, ensuring better maternal and neonatal health.

DOI: 10.5281/zenodo.10956902

Background: Human skin undergoes tremendous changes as age advances and also due to factors like exposure to sunlight, hormonal factors, stress etc. Changes can occur at macroscopic and microscopic levels. A better knowledge of the normal gross and histological features of each age group is essential for early diagnosis of any pathological abnormalities pertaining to that particular age group. This study aims to provide normal microscopic changes occurring in human skin in various age groups. The objective of the study is to find out the microanatomy of age related changes in human male skin and to correlate the changes in epidermal thickness. Method: A descriptive study on microanatomy of age related changes in human skin was conducted in the Department of Anatomy, Govt. T. D. Medical College, Alappuzha.  66 specimens of human male skin from anterior abdominal wall were collected from the Department of Forensic Medicine, after taking detailed informed written consent. The specimens were grouped into 4 different age groups. A study of microanatomical changes in epidermal thickness of human skin according to age was done using Haematoxylin and Eosin stain. Results: The changes in epidermal thickness were observed. After preparing the master chart in Microsoft Excel, the observations were analysed using SPSS Version 18. Conclusion: Epidermal thickness of skin showed an increase from 20 years, upto 60 years of age, and a decline was seen thereafter. Epidermal thickness is low in younger age group but the thickness increases as age advances, which might be due to increased mechanical work done in late teens and adulthood.

DOI: 10.5281/zenodo.10956942

Background: Endometrium is hormonally sensitive that constantly undergoes cyclical changes throughout reproductive life. Abnormal uterine bleeding (AUB) is a most common age related pathology that affects the quality of life in women. The present study was done to analyse and determine the histopathological patterns, bleeding patterns of endometrium among perimenopausal and postmenopausal women along with co morbidities. To identify the early precursor lesions and malignancies along with PTEN analysis for better management. Material and Methods: This is a three year prospective study conducted at Government medical college, Anantapuramu, from January 2021 to December 2023.Endometrial samples with clinical diagnosis of abnormal uterine bleeding among perimenopausal and postmenopausal women age group only were included in this study. Histomorphological patterns were studied using Haemotoxylin and Eosin stained sections. Immunostaining of PTEN was done wherever necessary. Statistical data analysis was done using SSPS software. Results: A total of 242 cases were studied. The prevalence of AUB is most common among perimenopausal age group women (77.6%). Menorrhagia (48.7%) was the common bleeding pattern. The functional cause (57.8%) of AUB was more common than Organic cause (42.1%).The most common histological pattern was the normal cyclical pattern showing proliferative phase (27.3%) followed by hyperplasias. Eight cases of endometrial carcinoma was observed most commonly among postmenopausal age group. Five cases were Stage IA, Three cases were Stage IB. PTEN immunostaing pattern was evaluated. Obesity and hypertension were most common comorbid conditions seen in this study. Conclusion: The study of histomorphological patterns of Endometrium helps during the workup to exclude organic pathology especially early detection of precursor lesion of malignancy among perimenopausal and postmenopausal age groups. PTEN expression decreases as lesion progress from benign to malignancy. Loss of PTEN function is an early event in endometrial carcinogenesis.

DOI: 10.5281/zenodo.10956973

Background: Total abdominal hysterectomy is one of the most commonly performed surgical procedures. Transversus abdominis plane (TAP) block is a recently introduced regional technique that blocks abdominal wall neural afferents between T6 and L1 and thus can relieve pain associated with an abdominal incision. Objective: This study was conducted in 64 female patients to assess total duration of analgesia as per Visual analogue scale (VAS) score, requirements of rescue analgesics, hemodynamic parameters, Side effects & Complications if any. Material and Methods: Patients were randomly allocated to one of the two groups of 32 patients each. In Group R (TAP block with 15 ml of 0.375 % Ropivacaine bilateral) given and in Group B (TAP block with 15 ml of 0.25 % Bupivacaine bilateral) given. The assessment of pain was done for 24hours. At any point of time if VAS is ≥4, intravenously Diclofenac sodium 25 mg was given to the patient as a 1st & 2nd rescue analgesic and for 3rd rescue analgesic intravenously Tramadol 75mg was given. Results: The mean total duration of analgesia was longer in ropivacaine group compared to bupivacaine group. The VAS pain score was significantly lower in ropivacaine group compared to bupivacaine. Total requirement of rescue analgesia was reduced in patients of group R as compared to patients of group B. Hemodynamics remained stable in both the groups. No complications were noted in any of group. Conclusion: TAP block as a part of multimodal analgesic regimen in patient with total abdominal hysterectomy provided reliable and effective analgesia in this study. 0.375% Ropivacaine provided longer duration of analgesia and resulted in lesser analgesic requirement than 0.25% Bupivacaine when used in TAP block and no complications due to the TAP block were detected.

DOI: 10.5281/zenodo.10956991

Introduction: Cholelithiasis is the most common benign gall bladder pathology. In recent times, the cases of cholelithiasis are on rise, and cholelithiasis is commonest indication for major surgical intervention among abdominal pathologies. Methods: A comparative type of prospective study with 46 subjects with cholelithiasis for a period of 6 months from September 2022 to March 2023 in a tertiary care centre. The aim was to compare the variation in the symptoms at the presentation, intra operative findings and difficulties in laparoscopy in case of single gall stone disease and multiple gall stone disease. Results: Incidence is common in the age distribution of 40-50 yrs mostly of female gender. Complications of cholelithiasis and difficulties in cholecystectomies are common in multiple stones. Conclusion: Severe symptoms, complications and difficulties during surgery are seen in multiple gall stone disease compared to single stone disease. These patients should be taken for early cholecystectomy even when incidentally found after thorough motivation and they should not be subjected to conservative management.

DOI: 10.5281/zenodo.10957007

Introduction: An effective pre-anaesthetic medication for use in children undergoing surgery is required to alleviate apprehension about anaesthesia and surgery, reduce trauma from separation from patents, and facilitate induction of general anaesthesia without lengthening the post-anesthesia recovery period. Aim And Objectives: The objective of comparative study between intranasal dexmedetomidine and intranasal midazolam as premedication in paediatric age group is to evaluate and compare the following effects between two groups. (1) Time of onset of sedation, (2) Duration of sedation, (3) Level of sedation, (4) Anxiolytic effect, Ease of child parent separation, (5) Side effects. Results: (1) The mean value of age with standard deviation are 6.43+1.43 Group D and 5.28+1.63 for Group M.  There was no significant difference between two groups (p<0.03). (2) Study group D had 73.3% male and 26.7% female subjects whereas Group M had 58.3% male and 41.7% female subjects.  No significant difference in sexwise distribution was observed between two study group. (3) Comparison of saturation of oxygen in the blood at an interval of 15,30,45 minutes respectively.  Group D had mean SPO2 of 98.03+0.86 at 45 minutes interval.  Whereas group 99.12+1.32 which is found to be statistically significant. (4) Mean sedation score at 15 minutes interval is 2.82+0.43 in Group D whereas in group M 4.83+0.39 (p<0.000) which is statistically highly significant. (5) Mean behavior score of 1.85+0.36 at 10 min. in group D whereas 2.87+0.34 in group M (p<0.000) which is statistically highly significant. Conclusion: Compared to midazolam, intranasal dexmedetomidine resulted in reduced sedation, easier child-parent separation, and faster postoperative recovery with no side effects. Thus, intranasal dexmedetomidine may be administered effectively and safely as a pre-anaesthetic medication in children undergoing minor surgical procedures under general anaesthesia.

DOI: 10.5281/zenodo.10957016

Background: Common nutritional problems in adolescents are anemia, growth retardation, protein deficiency-related infections, and obesity. Adolescent females are often affected by tuberculosis, scabies, thyrotoxicosis, conjunctivitis, ear disease, asthma, and oral diseases. Objectives: The objective is to investigate the nutritional status and co-morbidities in adolescent females. Methods: A study was conducted in Saharanpur, North India to assess the health of 400 females aged 10-19 years. The study collected detailed information on protein intake, iron-rich intake, milk intake, and calorie intake using a  pre-designed and pre-tested questionnaire is a set of questions that have been created and evaluated beforehand to ensure their effectiveness. Physical examination using ICD-11 was also carried out. The BMIs of the participants were evaluated and the chi-square test was used to compare the protein, iron-rich, milk, and calorie intake between those with BMIs below 18.5, between 18.5 and 24.9, and over 25. Results: The study found that there were significant associations between certain dietary factors and health conditions among the participants. Girls were more likely to have health issues than boys, with 55.5% of girls experiencing one or more of the conditions studied. The most common condition was pallor, affecting 29.4% of girls, followed by asthma (21.29%), tuberculosis (16.26%), dental caries (16%), thyrotoxicosis (15.7%), external ear disease (12.6%), conjunctivitis (8.37%), and scabies (5.74%).The statistical analysis revealed that protein intake and iron-rich intake were strongly associated with the risk of developing these health conditions, with x² values of 38.85 and 106.14 respectively and a P-value of less than 0.001 for both. Type of milk intake was also found to be a significant factor, with a x² value of 166.4 and a P-value of less than 0.001. However, calorie intake did not show a significant association with the risk of developing these health conditions, with a x² value of 5.87 and a P-value of greater than 0.05. Conclusions: The study found that teenage girls commonly suffer from health conditions that are caused by a lack of proper nutrition.

DOI: 10.5281/zenodo.10957042

Introduction: Breastfeeding has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of children. More than 15% of 24 lakhs child deaths could be averted in India by optimal breastfeeding practices. It is the ideal method suited for the physiological and psychological needs of an infant. It is estimated that the lives of one million infants can be saved in the developing world by promoting breastfeeding. Objectives: To assess the Knowledge, Attitude and Practices about Exclusive Breastfeeding among the antenatal women attending Sultania Zanana Hospital Bhopal. Material and Methods: After getting the approval from Institute Ethical Committee, this study was conducted in Antenatal clinic, Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal from the period of 1st August 2012 to 31st July 2013 among all the antenatal women with one live child (Primipara / Multipara) and are representing surrounding area of SZH. Participation of the selected women was fully voluntary after explaining the purpose of the study. Questionnaire of predesigned and pretested proforma developed in consultation with guide and faculty was filled for assessing Knowledge, attitude and practice about initiation of breastfeeding, pre lacteal feeding, colostrum feeding, exclusive breastfeeding, and duration of breast feeding. Women were interviewed regarding breastfeeding Practices for their youngest child. 1050 women were contacted, 1000 completed in depth interview, 50 refused the interview. Results: Knowledge difference for exclusive breastfeeding was found significant for age, religion, education. Knowledge was more in younger group compared to the elder group, more in Hindus (89%) compared to Muslim (77.23%), Literate (87.62%) compared to illiterate (68.57%). Practice difference for exclusive breastfeeding was not found significant for various demographic factors like residence, religion, education, SES, Type of delivery. But found significant for age variable, practice of exclusive breastfeeding was more in older group (65%) than younger group (9.85%). Conclusion: There was a big gap between actual and desired practices. Majority of women have positive attitude towards breastfeeding practices and wish to implement healthy practices.

DOI: 10.5281/zenodo.10957052

Background: Diabetes mellitus is a group of metabolic disorders that share the phenotype of hyperglycemia. CVD remains the principal comorbid condition and primary contributor to mortality in patient with diabetes, usually in the form of coronary artery disease. Genetic studies have shown association of β fibrinogen gene polymorphism with increased levels of serum fibrinogen and increased risk of MI in patients with CAD. Fibrinogen levels are frequently elevated in diabetes, regardless of diabetes duration, but particularly in those with type 2 diabetes and preexisting vascular complications. Fibrinogen being an acute phase reactant is also a procoagulant. It plays a major role in coagulation of blood. It has a significant role in athero-thrombosis. Objectives: To estimate serum fibrinogen level in type 2 diabetic patients and to associate the Fibrinogen level with major adverse cardiovascular events in type 2 diabetics. Methods: A Hospital based Cross sectional study included 70 study participants conducted between February 2021 to August 2022 in hospitals attached to BMCRI. Patients diagnosed with type 2 diabetes mellitus according to ADA guideline. Results: Mean TCH in subjects with arrythmias was 205.00+42.117, it was 204.00+36.333 in CCF, 205.57+33.297 in MI and 210.27+34.661 in recurrent angina. Mean HDL was 40.50+7.944 in arrythmias, 39.25+6.754 in CCF, 39.81+6.623 in MI, 38.55.09+8.722 in recurrent angina. Mean LDL was 117.83+43.273 in arrythmias, 128.88+36.515 in CCF, 126.76+38.188 in MI and 136.00+41.027 in recurrent angina. Mean TG was 236.67+77.871 in arrythmias, 179.28+63.849 in CCF, 194.57+71.152 in MI and 178.55+55.012 in recurrent angina. The duration of diabetes was found to be positively correlating with the serum fibrinogen levels. Conclusion: The study concludes that hyperfibrinogenemia among type 2 diabetic patients can be used as a predictor of major adverse cardiac events. Further case control studies with larger sample size is required to warrant the same.

DOI: 10.5281/zenodo.10957144

Background: Effective postoperative pain management remains a critical component of surgical care, impacting patient recovery and satisfaction. This study aimed to assess the impact of preoperative gabapentin on postoperative pain and recovery outcomes following laparoscopic cholecystectomy. Methods: A prospective observational study was conducted involving 120 patients undergoing elective laparoscopic cholecystectomy, randomized into gabapentin and control groups. The gabapentin group received 600 mg orally two hours before surgery. Outcomes measured included postoperative pain scores (VAS), analgesic consumption, incidence of PONV, patient satisfaction scores, and length of hospital stay. Results: The gabapentin group exhibited significantly lower VAS scores at all postoperative intervals (p < 0.001) and reduced morphine consumption (10 mg vs. 20 mg, p < 0.001). The incidence of PONV was also lower (20% vs. 41.67%, p = 0.015), and patient satisfaction was higher in the gabapentin group (8.5 vs. 7.0, p < 0.001). A marginal reduction in hospital stay was observed (2 days vs. 2.5 days, p = 0.02). Conclusion: Preoperative gabapentin significantly improves postoperative pain control, reduces opioid requirements, and enhances overall patient satisfaction after laparoscopic cholecystectomy. It should be considered a valuable component of multimodal analgesic strategies in this patient population.

DOI: 10.5281/zenodo.10957149

Introduction: Different polymers have been created and used therapeutically as denture foundation materials in dentistry.  heat cure acrylic resin, was first released in 1937; this substance, when created via the compression molding method, continues to be the preferred denture foundation material. The volumetric shrinkage of resin is the main factor mentioned for the denture base’s failure to adapt in the palatal and post-palatal seal region of maxillary dentures. Chemical activators, also known as cold-curing, self-curing, and autopolymerizing resins, were first employed in 1947 to induce polymerization at ambient temperature. photoinitiator systems with camphoroquinone as the initiator and visible light as the activator were used to create light-activated denture base resins. Aims and Objective: The objectives of this study was to evaluate the dimensional and volumetric shrinkage in all the four (heat cure acrylic resin, cold cure acrylic resin, light cure acrylic resin and shellac base plate) denture base  material. Materials & Method: An in vitro experimental study was carried out, where 4 types of acrylic resin were compared; Group 1 heat cure acrylic resin (Denstply), group 2 Self cure acrylic resin (Dentsply), group 3 light cure acrylic resin (dentsply), group 4 Shellac base plate (Pyrex). A typical flexible rubber mold was used to create a total of 40 prostheses (n = 10 per group) from high strength dental stone (type III stone). Conclusion : Dentures created using heat-cured acrylic resin displayed the maximum amount of polymerization shrinkage within the confines of the current investigation.

DOI: 10.5281/zenodo.10957158

Background: Placental insufficiency significantly impacts fetal development, yet the antenatal diagnosis of fetal growth restriction (FGR) is only about 30% accurate. Traditional assessments focus on the placenta’s position, maturity, and morphology. This study zeroes in on placental thickness, investigating its potential as an indicator of FGR and its correlation with neonatal birth weight. Materials and Methods: Conducted at a tertiary medical institute’s Department of Radiodiagnosis, this prospective observational study involved 100 third-trimester pregnant women referred for prenatal ultrasonography. It aimed to explore the relationship between placental thickness measured via ultrasound and fetal well-being, correlating these findings with ultrasonographic outcomes post-delivery. Results: The findings revealed a modest correlation (0.459, p < 0.01) between reduced placental thickness and lower birth weights in pregnancies beyond 32 weeks of gestation. All participants in this gestational age group with diminished placental thickness had newborns weighing below the 10th percentile. No notable correlation was found in pregnancies under 32 weeks. In cases of FGR, 8 out of 18 fetuses had thin placentas. Additionally, over 70% of infants with either significantly large or thin placentas exhibited poor Apgar scores, suggesting a link between placental thickness and neonatal health. Conclusion: Measuring placental thickness offers a practical addition to fetal biometry and Doppler studies for screening FGR. This method could improve the early detection and intervention strategies for pregnancies at risk, potentially enhancing outcomes for affected neonates.

DOI: 10.5281/zenodo.10957178

Aim: The purpose of present study was to evaluate interrelationship of various reference planes to occlusal plane in completely edentulous patient. Materials and Method: Forty completely edentulous subjects of age ranging from 55-65 years with Angle’s class I relationship were included in the study. For all the subjects, left lateral cephalograms were taken and cephalometric analysis was done and data obtained from cephalometric tracing were then statiscally analyzed. Result: Correlation of SN-OP and PP-OP to FH-OP was  found to be statistically highly significant (p<0.001) whereas correlation of MP-OP to FH-OP was not statistically supported (p=0.230). Conclusion: The palatal plane, Frankfort horizontal plane and Maxillary plane serve as a reliable guide to establish occlusal plane in edentulous subjects when two third of the retromolar pad area serve as a reference landmark.

DOI: 10.5281/zenodo.10957210

The skin is represented as the Mirror of the Mind which responds to both endogenous and exogenous stimuli. It senses and integrates environmental cues and transmits intrinsic conditions to the external world. Psychodermatology is a recent subfield of Psychosomatic Medicine which address the interaction between Mind (Psyche) and skin. The two disciplines are interconnected at the embryonal level by their origin from ectoderm and influenced by reciprocal action of neuroendocrine and immune systems. Materials and Methods: This study done at Dept: Dermatology, College: SMMCH & RI. Results: The sample   population consists of 52.9% females and 47.1% males. Among that 70% had Nonsegmental (Generalized) vitiligo and 30% localized/segmental type. The duration of illness was <5 years in 81.4% of patients, 6-12 years in 12.9% of patients and in 5.7%, it was > 13 years. Among the study population 70% (49 patients) had psychiatric illness, among that most common psychiatric illness was major depressive disorder (n= 22) constituting 31.4%. Conclusion: The study findings reveal, increased association of psychiatric illness in patients with. Major depression disorder is the most frequent psychiatric disorder     seen in patients with vitiligo. Generalised vitiligo associated with increased psychiatric co morbidities.

DOI: 10.5281/zenodo.10957256

Summary: The exact determination of vertical dimension of occlusion is of great significance for the recreation of the functional, esthetical and prophylactic biological factors for the edentulous patients. Authors aim was to establish the change in mm of the vertical dimension of occlusion by patients with different duration of full dentures treatment. Materials and Methods: 75 patients (44 women and 31 men) aged from 56 to 82 years, wearing complete dentures for 3 to10 years, were included in our investigation. On all patient’s plaster casts were made baseplates from photopolymerizing baseplates (TRIAD VLC Custom, Dentsply De trey) and occlusal rims from temperature resisting pink wax (Modern Pink No. 3 Wax, Heraeus Kulzer, GMBH & Co.KG). The numbers of measurements of the physiologic rest position for every patient were 10. After calculating the average value of measurements the result was minimized with 2.5 mm thus giving the vertical dimension of occlusion (VDO) for the new denture treatment. Results and Discussion: By 49 patients (65, 33%) the difference between the VDO with the old dentures and the new treatment was from 2 to 3.99 mm. By 17 patients (22, 67%) that difference was from 4-5.99 mm and by 9 patients (12%) – from 6-8 mm. By all the patients the VDO had to be increased with 2-6 mm by the new treatment.

DOI: 10.5281/zenodo.10957282

Background: In Cholesteatoma of the earthe ossicles are damaged to a great extent, sometimes leaving only the foot plate of stapes. Type III Tympanoplasty only remains the choice of method for restoring the hearing mechanism. The present study aims to assess the final long term hearing gain in different aged patients undergoing Type III Tympanoplasty procedure. Aims and objectives of the study: To assess and analyze the final long term hearing outcomes in patients undergoing canal wall down mastoidectomy with Type III Tympanoplasty procedure using stapes columella graft; to determine the graft success rate, and recurrence of Cholesteatoma. Materials: This study examined patients undergoing Type III Tympanoplasty with stapes columella grafting in 62 patients undergoing canal wall down Mastoidectomy for Cholesteatoma. Demographic data, Clinical findings of retraction pockets in Tympanic membrane, X-Ray, CT scan findings, ossicualr damage and type of ossicualr prosthesis used were analyzed.  Auditory assessment before and after surgery in terms of Air, Bone conduction values, PTA and air bone gap were taken as success criteria. Hearing acuity was assessed at 03 monthly intervals to observe the auditory gain in terms of air bone closure and PTA. Results: 62 patients with CSOM with CH, satisfying the inclusion criteria were included. Males were 69.35% and females were 30.64%. The male to female ratio was 2.26:1. Patients were aged 20 to 50 years with mean age of 29.65±8.08 years. The mean values of PTA were 22.14± 4.23 in 31 (50%) patients, 30.20± 2.15 in 29 (46.77%) patients and 33.18± 3.10 in 02 (03.22%) patients at the end of 12 months; the air, bone conduction, air bone gap, PTA values were statistical significance, as the p value was <0.05. Conclusion: Type III Tympanoplasty procedure is an ideal method of eradicating CH and restoring the hearing to optimal levels. The status of ossicles following erosion by the disease determines the method of reconstruction and auditory gain. The type of ossicular prosthesis used has no significant role in achieving the auditory gain. The present study has presented a small data but it reflected the literature reviews of the benefit of Type III Tympanoplasty in CH management with low recurrence rates and long term auditory gains for the patients. A larger surgical series would confirm further the benefits of such procedure.

DOI: 10.5281/zenodo.10957310

To evaluate the variation in vertical magnification of digital panoramic machine Kodak 8000 Panoramic System in relation to different regions of maxillary and mandibular edentulous arches and to compare this variation in magnification. The study sample of 40 patients was divided into 2 different groups (20 each) depending upon the two different diameters of metallic spheres i.e., 3mm & 6mm used as radiographic reference. Each group was further subdivided into 2 subgroups depending upon the arch of placement of metallic sphere. The metallic spheres were placed in 4 different regions of maxilla and mandible. Digital panoramic radiograph was obtained and was subjected for measurement using Trophy Dicom Software. Data was analyzed statistical analysis by paired “t” test and student “t” test. The present study has established that there is variation in magnification both in vertical and horizontal direction for maxilla and mandible. In maxillary arch vertical magnification rate shows lowest values for 3mm spheres in right posterior, right and left anterior regions. In mandibular arch vertical magnification shows lowest values for 3mm spheres in right and left posterior, right anterior regions. The vertical magnifications in posterior regions were higher than anterior region. On comparing the magnification of maxilla and mandible, values were higher in maxilla. The study concludes that radiographic reference objects (use of metallic spheres) can be used as a steady method for radiographic assessment in edentulous patients, as there is variation in the magnification in both maxillary and mandibular arch area specifically.

DOI: 10.5281/zenodo.10957338

Background: Urban development and the increasing number of vehicles have led to a significant public health concern in modern Indian cities: air pollution. Considering the demands and environment of their work, traffic policemen may experience respiratory issues such as asthma, chronic obstructive pulmonary disease, rhinitis, recurrent respiratory tract infections, and other related illnesses. Objectives: Our study aimed to evaluate the lung volumes and capacities of traffic police personnel stationed at different traffic junctions in the Western Gujarat region. Our objective was to explore the possible impacts of extended exposure to vehicle exhaust on lung function. Furthermore, the study aimed to investigate whether there was a correlation between the duration of exposure to vehicle exhaust among traffic police personnel and any potential decrease in lung function. Materials and Methods:  A control group of 250 males, all in good health and of similar age, was included in the study. These individuals were working in different government departments in Gujarat and had not been affected by traffic pollution. Furthermore, there was an additional cohort of 250 individuals who worked as traffic police personnel. A pretested, semi-structured questionnaire was used to gather information on demographic profile, duration of exposure, smoking history, allergy/asthma history, and the use of personal protective measures. A pulmonary function test (PFT) was conducted to evaluate lung function using computerised spirometry. Results: In the study, a group of 250 traffic policemen were included. Most of the participants, 92% to be exact, were male, leaving only 8% who were female. The average age was 36.22 ± 2.1 years. Most of them had a bachelor’s degree. The recorded anthropometric data of traffic police did not show any statistically significant difference. The statistical significance level was found to be less than 0.05.  When it comes to traffic policemen and controls, it has been found that traffic policemen tend to have significantly lower values for FVC, FEV1, FEV1/FVC, MVV, and Peak expiratory flow rate (PEFR).The statistical significance level was found to be less than or equal to 0.05. Conclusion: Spirometry can be a valuable tool for identifying respiratory illnesses in traffic policemen. Being exposed to respiratory pathogens, like air pollution, can make it a useful screening tool for health journalists. Regular medical surveillance, including spirometry, is advised to evaluate pulmonary function and aid in the early detection and treatment of potential issues.

DOI: 10.5281/zenodo.10957351

Introduction: Anaerobic bacteria cause a wide spectrum of infections varies from local to systemic. The infection is generally polymicrobial. Both sporing and non-sporing anaerobic bacteria are the causative agents. Recovery of anaerobes from clinical specimen is overlooked and neglected. Isolation of anaerobes requires proper sample collection, prompt transport in anaerobic container and anaerobiosis. Aims and Objectives: The study was conducted to determine the rising trends of anaerobes isolated from various clinical specimens, to review the clinical manifestation and to achieve better clinical outcomes through active surveillance. Materials and Methods: The study was conducted in the Microbiology Laboratory of a multispeciality corporate hospital of Burdwan town, WB, over a period of 6 months from March,2022 to Sep,2022. Forty samples were collected from suspected patients admitted in different Department. Samples were inoculated onto Anaerobic blood agar and Bacteroides bile esculin agar (Himedia) and placed inside anaerobic Gaspak Jar (BD). Anaerobic indicator was also put inside the jar and the whole system was incubated at 37℃ for 24-48hrs. Automated identification of bacteria to spices level was completed by Vitek 2 ANC cards (BioMerieux). Antimicrobial susceptibility testing (AST) – the disc diffusion method was performed on Fastidious anaerobic agar with McF1.0. Result: A total 40 samples were processed from suspected anaerobic infections over a period of 6 months in the Microbiology Laboratory of a multispeciality corporate hospital of Burdwan. Thirty two (32) anaerobic bacteria were isolated out of 40 samples,8 showed no growth. Sixteen (16) anaerobes were monomicrobial, rest were polymicrobial out of 32 specimens. In our findings, monomicrobial infections were responded by metronidazole and doxycycline followed by clindamycin, whereas polymicrobial infections were treated smoothly by meropenem- colistin combination with clindamycin. Discussion: Our data shows that anaerobic bacteria can be isolated from a variety of infections. The most common sites of isolation were abscesses (40%) followed by soft tissue infections (10%). Anaerobic bloodstream infections (ABSIs) are not very common. Similar results were also observed by Gorbach SL et al.  They can be serious and even fatal if left untreated. Here, only one ABSI was there caused by Bacteroides fragilis. In our study, 17 (42.5%) were Gram positive bacilli (GPB), 8 (17.5%) were Gram negative bacilli (GNB) and 7 (17%) were Gram positive cocci (GPC). Most commonly isolated organism is Actinomyces sp.(10%) followed by Clostridium sp.(7.5%) And Peptococcus sp.(7.5%). However, other reports have shown that Gram-positive anaerobic cocci (GPAC) are the most frequently isolated pathogens. In monomicrobial anaerobic infection, Actinomyces sp. (37.5%) is the most commonly isolated sp. followed by Fusobacterium sp. (25%).

DOI: 10.5281/zenodo.10957969

Purpose: To record the incidence of cognitive dysfunction in edentulous patients suffering from obstructive sleepapnea (OSA) and establish a plausible hypothesis to explain the correlation of cognitive dysfunction and OSA. Materials and Methods: In this study, 315 edentulous patients (aged 60 to 65 years) visiting the outpatient department at Saraswati Dental College, Lucknow were recruited from January 2021 to October 2023. Prosthodontic Diagnostic Index (PDI) classification was used to assess the intraoral condition to relate it with the span of edentulousness. The BERLIN questionnaire and Epworth Sleepiness Scales were used to diagnose sleep-disordered breathing, following which the patients were put through all-night polysomnography. The apnea-hypopnea index (AHI) scores were derived. Mild and moderate OSA patients were classified into mild, moderate, and severe cognitive dysfunction based on SGRQ-C and SCD. Data were tabulated according to a new classification (Cognitive Dysfunction of Dental Sleep Medicine Patients [CDDSMP] Classification) designed specifically for this study. Data were analyzed using SPSS v15.0. Scores were tabulated as mean ± SD and median [IQR] values. Change from baseline was analyzed using Wilcoxon signed rank test. Results: Mean scores at different time intervals were 3.03 ± 1.76 (3 months), 2.98 ± 1.80 (6 months), and 2.81 ± 1.84 (9 months). The median [IQR] values of scores at all time intervals except 9 months were 3 [1 to 5]. At 9 months, median [IQR] was 2 [1 to 5]. A significant change in scores was observed in the 3-month interval (p _ 0.001). Conclusions: The severity of OSA and neurocognitive dysfunction could be directly related to the PDI classification and the span of edentulousness of the patient and modified mandibular advancement device treatment significantly improved the patients’ condition, which was reflective from 3 months post-intervention itself.

DOI: 10.5281/zenodo.10957978

Background: Olecranon fractures represent a relatively frequent occurrence, comprising roughly 10% of all upper extremity fractures and 40% of fractures in the vicinity of the elbow joint. These fractures commonly stem from direct or indirect trauma, frequently associated with forced hyperextension of the elbow joint. In cases of non-displaced olecranon fractures, a conservative management strategy is often appropriate. The objective of this prospective study was to evaluate the functional outcomes resulting from anatomical plate fixation for olecranon fractures, encompassing both simple and comminuted cases. Methods: A total of n=20 cases of olecranon fractures were included in the study based on the inclusion and exclusion criteria. The treatment approach involved using tension band wiring with Kirschner wires for simple transverse fractures and an olecranon hook plate for comminuted fractures and a strong focus on clinical observation and the subsequent analysis of outcomes following surgical management of olecranon fractures using Kirschner wires with tension band wiring and olecranon hook plates. Results: In this study 15(75%) cases were with excellent scores of 90 – 100. N=3(15%) cases had good scores of 80 – 89. The scores of 70-79 are considered fair in this study in 2(10%), cases. The scores below 60 are considered poor or unacceptable no case in this study were with scores below 60. In this study, the total number of complications was in 2(10%) cases which included 2 cases of superficial infections that were adequately managed by antibiotics. Conclusion: The current study concludes that the application of open reduction and internal fixation, utilizing Kirschner wires and tension band wiring for simple transverse and oblique fractures, along with olecranon plate fixation for comminuted fractures, proves to be an effective and established approach. 70% of patients in this study achieved excellent Mayo Elbow Performance Scores (MEPS), while an additional 20% obtained good MEPS scores. Significantly, none of the study participants demonstrated poor or unacceptable MEPS scores. These results indicate a notable success rate in the management of olecranon fractures, with the majority of patients realizing favorable and excellent functional outcomes.

DOI: 10.5281/zenodo.10957986

Purpose: To study the structural changes occurring in the dental porcelain mass fired at various firing temperatures using scanning electron microscopy (SEM) and X-raydiffraction (XRD) spectroscopy. Also, additional tests, namely compressive strength, abrasion resistance analysis, and the amount of oxides released, were conducted at different firing temperatures. Materials and Methods: Six groups (40 specimens in each group) of porcelain mass were prepared. The dimensions and weight of all the specimens were kept constant. The specimens were then heat treated at different firing temperatures (660°C, 760°C,860°C, 900°C, 960°C, 990°C). Half of the specimens of each group were subjectedto a compressive strength test on a universal testing machine and then finely ground using an electrochemical grinder to prepare for XRD analysis. The other half of the specimens was weighed to analyze the amount of oxides released after each firing cycle. Following this, the specimens underwent an abrasion resistance test on a Nanovea Tribometer. The unaltered surface was scanned using SEM. The data (numerical and graphical) for all the tests were recorded and analyzed using one-way ANOVA and post hoc Tukey test. Results: The specimens fired at 900°C exhibited superior compressive strength and abrasion resistance. The quantity of oxides released by the specimens fired at 900°Cwas the least compared to specimens heat treated at the other firing temperatures. XRD analysis proved that the oxide released by the porcelain mass was calcium aluminum chromium oxide. Also, the fewer peaks obtained in the XRD graphs of specimens fired at 900°C signified lesser porosities in the porcelain specimens. SEM analysis depicted a homogeneous mass of porcelain at 900°C. Conclusion: All the above findings validate the objective of studying the physical and internal structural changes of dental porcelain when subjected to an increasing firing temperature gradient. The specimens fired at 900°C exhibited superior strength and abrasion resistance. SEM analysis depicted a homogeneous mass of dental porcelain, implying that firing was complete at 900°C.

DOI: 10.5281/zenodo.10957988

Introduction: The intended aim of surgical treatment of fracture is to restore the pre-existing anatomic relationships and acceptable function by stable fixation. This study evaluates immediate and late post-operative complications as well as the time taken for approaching the condyle in treating subcondylar fractures by two approaches; namely the RMTP and TMAP. A TMAP technique offers rapid access with reduced risk to the facial nerve along with elimination of the complications associated with RMTP approach. Materials & Methods: This study was carried out on total of 15 patients with 20 condylar fractures and randomly divided into 10 each in group I (RMTP approach) and group II (TMAP approach) respectively. For the statistical analysis the data were analyzed with computer-run statistical program. Results: The operating time taken in minutes for the group II i.e., Transmasseteric Anteroparotid Approach [22.70(mean) + 2.21(std deviation)] was far less than that for group I i.e., Retromandibular Transparotid Approach [59.40(mean) + 5.58(std deviation)]. Other Post-operative parameters like Inter-incisal Opening, Pain, Swelling, Function of Facial Nerve, Scar, Fistula are also compared in the present study. Conclusion: Both the approaches have good results in managing condylar fractures with TMAP approach having lesser time in gaining access to the condyle.

DOI: 10.5281/zenodo.10957992

Background: Obesity is considered unaesthetic and a social stigma, with severe health outcomes. Overweight / obese children are three times more prone to have hypertension because it causes increase in arterial stiffness which opens on to atherosclerotic vascular changes in young adulthood. Presence of childhood obesity, Insulin Resistance (IR) and its consequences may be amplified by puberty because of physiological decrease in insulin. Methodology: One hundred and fifty subjects were examined for anthropometric parameters, blood pressure and biochemical parameters. Estimation of serum insulin was done by Enzyme-Linked Immunoassay method and Homeostatic Model Assessment (HOMA-IR) was calculated as: [HOMA-IR = fasting serum insulin (μ U/ml) × fasting plasma glucose (mmol/l)/22.5]. Results: Mean serum insulin and HOMA-IR were significantly higher among obese children i.e., 14.96±3.86 and 2.93±0.99 respectively as compared to that among healthy adolescents i.e., 6.97±1.38 and 1.27±0.28 respectively. Conclusion: The present study concludes that the obese children are at a higher risk of developing metabolic abnormalities because of increased level of insulin and insulin resistance.

DOI: 10.5281/zenodo.10957997

Background: Diabetes Mellitus, with a history tracing back to 1500 BC, has evolved into a global epidemic, particularly impacting low and middle-income countries. The chronic condition, characterized by the body’s inability to produce or properly use insulin, leads to elevated glucose levels in the blood. Type 2 Diabetes Mellitus (T2DM), the most prevalent form, is significantly influenced by urbanization, diet, and lifestyle changes. This study aims to explore the prevalence and risk factors of T2DM and Impaired Glucose Tolerance (IGT) in the urban setting of Katihar City, Bihar, to provide insights into the scope of these conditions and their association with various socio-demographic and lifestyle factors. Methods: Conducted in Sharifganj, Katihar, this community-based cross-sectional observational study involved 1050 adults aged 20 years and above, selected through systematic random sampling. Data were collected via interviews and physical measurements, with statistical analysis performed using MS Office Excel 2016 and SPSS-20. Results: The study found a T2DM prevalence of 9.24% and an IGT prevalence of 12.48%, with notable risk factors including age, family history, dietary habits, tobacco use, hypertension, and obesity markers such as high BMI and increased waist-hip ratio. The majority of participants were in the 51-60 age group, with a slight male predominance. Conclusion: The high prevalence of T2DM and IGT in Katihar City underscores the urgent need for public health interventions focusing on awareness, early screening, and the promotion of healthier lifestyles. Recommendation: Strategies should target improving dietary habits, increasing physical activity, and providing targeted interventions across different socio-economic groups to effectively manage and prevent T2DM and IGT.

DOI: 10.5281/zenodo.10958006

Introduction: Surgical haemorrhoidectomy is indicated for the treatment of third and fourth- degree symptomatic haemorrhoids. However, surgery is associated with severe post -operative pain that is a source of such anxiety that some patients decide not to undergo the operation. Post haemorrhoidectomy pain seems to be significantly associated with a spasm of the internal anal sphincter. Calcium channel blockers (CCB), are effective in reducing anal resting pressure Therefore, it seems likely that an ointment containing Diltiazem (CCB) may be  considered as a treatment that affects one of the supposed causes for pain after  haemorrhoidectomy. Aims: To determine, if application of topical calcium channel blocker (Diltiazem) in post haemorrhoidectomy patients would improve pain control as compared to placebo ointment. Materials and Methods: This was a prospective randomized case control study. 60 patients with Grade- III and Grade-IV haemorrhoids admitted in Government medical college Kota was randomly divided into two groups, consisting of 30 patients in each group. In group A: Calcium channel blocker (Diltiazem) ointment was applied topically and in Group B: Placebo ointment applied topically after haemorrhoidectomy for postoperative pain relief. Patients were followed up to four weeks and postoperative pain score was assessed in term of visual analogue scale after six hours, 24 hours, 48 hours and seven days after haemorrhoidectomy. Any complications after haemorrhoiectomy were checked. Results: Our study shows that mean pain score in term of visual analogue scale (VAS) were less in Calcium channel blocker (Diltiazem) group as compared to placebo group and it was statically significant (p-value <0.05). The comparison of mean pain score in Calcium channel blocker (Diltiazem) group and in Placebo group was 7.75 and 8.35 at 6 hours, 6.24 and 7.30 at 24 hours, 3.75 and 5.65 in 48 hours, 1.76 and 3.40 at 7 days respectively. So, pain score suggests that there was less pain score   Iin diltiazem group as compared to placebo group. Mean Postoperative hospital stay was also less in diltiazem group (3.03 days) as compared to placebo group (4.06 days). P-value-0.011. Conclusion: We conclude that perianal application of 2% diltiazem ointment along with standard treatment significantly reduces pain after open haemorrhoidectomy. Therefore, this management strategy should be considered as  an adjunct in reducing post haemorrhoidectomy pain along with standard treatment.

DOI: 10.5281/zenodo.10958017

Background: The measurement of B-type natriuretic peptide (BNP) levels after hospital discharge is a key indicator for evaluating prognosis in patients with decompensated heart failure. Monitoring BNP levels is essential for risk stratification because they correlate with higher mortality and hospital readmission rates in this patient group. Methods: This study followed a prospective cohort of 50 patients who had been hospitalized for decompensated heart failure and were discharged from Darbhanga Medical College & Hospital. BNP levels were measured one month after discharge. The study also tracked mortality and readmission rates over one year, employing Kaplan-Meier survival analysis and Cox proportional hazards models for statistical assessment. Results: Over the one-year observation period, 24% of the participants passed away, and 44% were readmitted for heart failure complications. Patients with BNP levels exceeding 300 pg/mL at one month post-discharge were at a significantly greater risk of dying (33% vs. 12%, p = 0.04) and being readmitted (55% vs. 30%, p = 0.02) than those with lower levels. High BNP levels (>300 pg/mL) were confirmed as independent predictors of both mortality (Hazard Ratio [HR], 2.8; 95% Confidence Interval [CI], 1.2-6.5; p = 0.02) and readmission (HR, 2.3; 95% CI, 1.1-4.8; p = 0.03). Conclusion: The study underscores the significance of monitoring BNP levels in identifying patients at an increased risk of mortality and readmission following hospitalization for decompensated heart failure. Elevated BNP levels (>300 pg/mL) serve as a crucial prognostic tool for guiding risk assessment and management. Recommendations: To improve outcomes for patients discharged after decompensated heart failure episodes, it is recommended to include BNP level assessments in their post-discharge care plans. This approach facilitates the early identification of patients at high risk of adverse outcomes, enabling timely and targeted interventions.

DOI: 10.5281/zenodo.10958019

Introduction: Bronchoalveolar Lavage (BAL) is a diagnostic procedure used to retrieve cells and various components from the bronchial and alveolar spaces for a range of investigative purposes. This minimally invasive day-care procedure serves a pivotal role in the diagnostic assessment of interstitial lung diseases, pulmonary infiltrates, and infectious conditions. Aims and Objectives: (1). To evaluate the diagnostic accuracy of specimens acquired through bronchoalveolar lavage (BAL). (2). To explore their correlation with histopathological findings wherever available, both in cases of malignant and non-malignant lung lesion. Material Methods : The retrospective and prospective observational study was conducted in cytology department over 19 months. For prospective analysis all BAL samples sent for cytological study were included while for retrospective analysis cytology reports of BAL samples were studied from records and included in the study. Cytology staining of smears was done and cytology evaluation was done by two cytologists. Histopathology correlation done on cases of positive for malignancy wherever available. Sensitivity, specificity diagnostic accuracy of BAL was obtained using SPSS software package version 22. Results: In our study 61 cases of BAL for cytology were studied. Patients were presented with mainly complaints of cough (46%) and breathlessness (40%). Cases were broadly classified into 3 categories on cytology as 52%  non- neoplastic, 41% were neoplastic and 7% were inadequate. After correlating cytology  and histopathological diagnosis in 26 cases there was 1 false positive and 1 false negative case  giving the sensitivity, specificity and accuracy of BAL cytology of  95%, 83.33% and 92.31% respectively with highly signficant p value  indicate almost perfect agreement. Conclusion: BAL cytopathology gives valuable adjunct to conventional diagnostic methods, offering insights into a spectrum of pulmonary diseases, including infections, inflammatory conditions, and neoplastic. In a tertiary care hospital, where complex and challenging cases are often encountered, the utility of BAL in cytology is indispensable. It aids in accurate diagnosis, guides appropriate treatment plans for patients.

DOI: 10.5281/zenodo.10958031

Helicobacter pylori colonize epithelium lining of the gastrointestinal tract and disrupt the function of the epithelial barrier, leading to changes and inflammatory responses that rely on H. pylori virulence factors. This further leads to actin cytoskeleton reorganization in epithelial polarity, structural and functional changes leading transiting to mesenchymal characteristics. By following the changes from grade 1 to grade 4, our study examined epithelial mesenchymal transition in various grades of gastrointestinal diseases. Additionally, the function of claudin-3 and claudin-4 in different grades of gastrointestinal disease was investigated. In comparison to the control group, we observed reduced expression of claudin- 3 and claudin-4 in different grades of gastrointestinal diseases. Compared to grade 1 and grade 2 gastrointestinal diseases, there was a significant reduction in the expression of claudin-3 and claudin-4 in grade 3 and grade 4 gastrointestinal diseases. Tight junctions require claudin as a necessary component in order to preserve epithelial homeostasis and cell-to-cell integrity. Comprehending the roles of claudin-3 and claudin-4 will help to clarify the underlying molecular mechanisms causing gastrointestinal disorders as well as open new opportunities for exploring the creation of new treatments.

DOI: 10.5281/zenodo.10958040

Background: FNAC is now a commonly used method for identifying breast lesions because of its safety, ease of use, and high diagnostic accuracy. The purpose of this study is to evaluate the accuracy of benign breast le-sion diagnosis using fine needle aspiration cytology (FNAC). In order to assess the diagnostic efficacy of FNAC, women with benign breast lesions identified by FNAC underwent histological analysis. Methods: From January 2019 to June 2020, this study was carried out in the Pathology Department of the Na-landa Medical College and Hospital, Patna, Bihar. 180 female patients, ages 10 to 60, are enrolled in the NMCH, Patna, Bihar, outpatient department. Results: With a 96.7% diagnostic accuracy for benign breast lesions, FNAC revealed 180 benign cases, of which 174 were benign. In contrast, 3 cases of fibrocystic disease and 3 cases of mastitis, respectively, had infil-trating ductal carcinoma. Conclusion: FNAC is a reliable test for detecting and managing benign breast lesions because cytology and histology are associated.

DOI: 10.5281/zenodo.10958056

Background: After diabetes mellitus, thyroid gland disorders are the most prevalent endocrine conditions found in clinical settings. The ability to distinguish between benign and malignant thyroid nodules is aided by ultrasound parameters and their lives with cytology findings. The purpose of this study is to assess thyroid nodules by correlating ultrasound results with fine needle aspiration cytology. Methods: From July 2020 to December 2020, the Pathology Department at NMCH, Patna, Bihar, collaborated with the Radiology Department to perform this prospective observational study. Forty more patients were sent to the pathology department for fine needle aspiration. These patients had their thyroid swelling examined with ultrasonography. Results: Of the forty patients with thyroid lesions, the largest number, or 25 percent, is in the age range of 31 to 40 years old, and the majority, or 77.5%, are female. 52.5% of the lesions had a single nodule, while 47.5% had several nodules. Consequently, it was discovered that there was a strong correlation between malignancy and internal vascularity, whether or not peripheral vascularity existed. It was discovered that malignancy and hypoechogenicity had a strong correlation. A noteworthy correlation was also discovered between malignancy and a solid or primarily solid component. Conclusion: When analyzing thyroid nodules, the combination of all imaging features on USG has a substantial association with FNAC and has a high correlation with sensitivity of 85.71% and specificity of 90.91% with 95% confidence interval for identifying malignancy. Therefore, in skilled hands, the combination of USG findings can identify whether the thyroid nodule is malignant. This straightforward, risk-free, and economical study’s accuracy can be compared to FNAC, which is saved for unclear lesions.

DOI: 10.5281/zenodo.10958074

Background: Higher levels of chronicity, symptom severity, substantial functional impairment, and a poor response to medication treatment are all related to anxious depression. There is, however, little data supporting first-choice antidepressants in individuals with anxious depression. The purpose of this study was to assess the safety and effectiveness of desvenlafaxine and escitalopram in the acute treatment of anxious depression. Methods: The study included a total of 100 participants who were diagnosed with anxiety and depression. At random, the patients were divided into two groups with a 1:1 ratio. The test group received desvenlafaxine, whereas the control group received the usual medicine of escitalopram. For a total of eight weeks, both drugs were taken orally once daily. In the first, fourth, and eighth weeks, the patients were monitored. The effectiveness ratings of the Hamilton depression rating scale (HAM-D) and the Hamilton anxiety rating scale (HAM-A) were contrasted. Patients who showed a 50% decrease in rating ratings from baseline or less during follow-up visits were deemed to be responding to treatment. To assess safety and tolerability, changes in laboratory data, vitals, and reported side effects were taken into consideration. Results: Both the escitalopram and desvenlafaxine groups’ HAM-D and HAM-A scores markedly declined from their respective baselines (P < 0.001). However, neither group was able to show a statistically significant difference at 4 or 8 weeks of treatment. It was concluded that both escitalopram and desvenlafaxine were safe; however, escitalopram exhibited a higher tolerance and a much lower number of side effects than desvenlafaxine. Conclusion: Desvenlafaxine and escitalopram both worked equally well to lessen the symptoms of depression associated with anxiety. It was shown that escitalopram was well tolerated.

DOI: 10.5281/zenodo.10958582

Background: Peripheral neuropathic pain (DPNP) in diabetics is prevalent and frequently bothersome. The majority of guidelines suggest starting DPNP patients with amitriptyline, duloxetine, pregabalin, or gabapentin as an analgesic medication; however, there isn’t much comparison data to suggest which is preferable or whether to mix them. The study’s objective was to evaluate the safety and effectiveness of Amitriptyline, Duloxetine, and Pregabalin in lowering neuropathic pain and enhancing sleep quality in DPN patients. Methods: In a prospective and observational trial, 75 outpatients (25 per patient) prescribed any of the aforementioned medications were progressively enrolled. By comparing the mean monthly visual analogue scale (VAS) score from baseline obtained from the pain diary drug effectiveness was evaluated. The Nottingham Health Profile (NHP) questionnaire’s overall and domain-wise scores were compared in order to determine QoL. By comparing the frequency of adverse drug reactions (ADRs), safety was evaluated. The Chi-square test and one-way analysis of variance were used to compare the qualitative and quantitative outcome measures, respectively. It was deemed statistically significant when P < 0.05. Results: Between the three medications, there was a comparable difference in mean monthly VAS scores at the end of 4, 8, and 12 weeks. Compared to patients on other medications, PGN patients experienced smaller overall favorable effects as well as in the affective, energy, and sleep domains of NHP. All medications caused drowsiness and vertigo, however PGN caused the least amount of sedation overall. Conclusion: These three medications all demonstrated comparable effectiveness in lowering diabetic polyneuropathy pain and enhancing the caliber of sleep. In this rural financially deprived group, amitriptyline may be preferred above the other two due to its relative affordability.

DOI: 10.5281/zenodo.10958604

Background: The symptoms and indicators of PCOS are brought on by a prevalent metabolic and reproductive condition that affects women. Worldwide, it is thought to affect 4% of women who are childbearing age; however, in populations where the risk is higher, other sources suggest that the number is closer to 10%. The purpose of the study is to ascertain and compare, in PCOS patients, the rates of ovulation, regularization of the menstrual cycle, and pregnancy by using a combination of clomiphene citrate and metformin as well as clomiphene citrate alone. Methods: A total of 110 patients, 55 in each group, who were diagnosed with PCOS and had primary subfertility and were between the ages of 18 to 40 were chosen between June 2023 and November 2023. Folliculometry was used to identify the main result, or the incidence of ovulation. The regularization of the menstrual cycle and the rates of pregnancy were considered secondary outcomes that were compared between the two groups. Results: The third cycle of ovulation induction was when overall ovulation was determined to be highest, occurring in each group at 48.8% and 41%, respectively. When clomiphene citrate and metformin were given together, group A primary outcome was considerably greater (83.3%) than when clomiphene citrate was given alone (65.9%). In the group receiving metformin with CC, the secondary outcomes were much higher (89.6%). The first group had a greater pregnancy rate 33.3% than the second group (20.5%). Conclusion: In the present study, two groups received different dosages of clomiphene citrate: one had it in combination with metformin, while the other received it only for the purpose of inducing ovulation. It was discovered that inducing ovulation in PCOS-affected women with a combination of clomiphene citrate and metformin was superior to using clomiphene citrate alone.

DOI: 10.5281/zenodo.10958646

Background: A complex combination of diffuse parenchymal lung conditions, interstitial lung disease is characterized by restrictive physiology, decreased gas perfusion, inflammation of the lung parenchyma, and fibrosis. The pulmonary interstitium, which is made up of the connective tissue space between the alveolar epithelial cells and the nearby capillary endothelial cells, is primarily responsible for the pathophysiology of interstitial lung disease. Methods: The study was conducted from July 2022 to December 2022 in the department of Respiratory Medicine at Varun Arjun Medical College, Banthra, and Shahjahanpur. Total 60 patients, 36 male and 24 female included in this study. The male female ratio 1.5:1. Results: Exertional dyapoea was the most common presenting symptom; second most common symptom was nonproductive cough. COPD was the commonest comorbid illness, second commonest comorbid condition absorbed was mellitus. Out of the 36 men, 25 were Smokers (42%) of the 19 Patients with IPF 16 were smokers. Average smoking index was found to be 180. 21.58% patients had upper zone predominance in chest x- ray. 4 out of 60 patients had mid zone perihilar distribution of lesion. 29 out of 60 patients had lower zone predominance. Spirometry showed restrictive in 86 % of Patients. Conclusion:  The profile of ILDs with their demographic, clinical and outcome data were analyzed and compared with other regional and global studies. The results recognized certain similarities and differences compared to other reports, formulating a distinctive study among others. Idiopathic interstitial pneumonias were the commonest type of ILD in studied sample, followed closely by secondary ILDs.

DOI: 10.5281/zenodo.10958727

Background: Dyspnea, a very upsetting sensation of dyspnea that interferes with daily tasks, is becoming more common in individuals with respiratory conditions including chronic obstructive pulmonary disease (COPD). This study set out to find out how often dyspnea is in COPD patients and what factors are linked to it. Methods: Ninety COPD patients from the Department of Respiratory Medicine at Varjun Arjun Medical College participated in this cross-sectional study. The modified Medical Research Council Dyspnea Scale and the Dyspnea 12 Questionnaire were used to evaluate the dyspnea of the patients. The Hospital Anxiety and Depression Scale was employed to gauge the patient’s anxiety and depression, and the COPD Assessment Test (CAT) was utilized to gauge the effects of the disease. The Kruskal-Wallis and Mann-Whitney tests were utilized to determine the relationship between the variables. Using multiple regression analysis, the most important component connected to dyspnea was identified. Results: Out of 90 patients, 76 male and 14 female practically all (92.8%) patients exhibited some degrees of dyspnea. Dyspnea was statistically significantly associated with age (P < 0.001), education (P < 0.001), marital status (P < 0.001), type of family (P = 0.009), working status (P < 0.001), duration of illness (P < 0.001), history of previous hospitalization (P < 0.001), status of hospitalization in the last year (P < 0.001), domiciliary oxygen therapy (P < 0.001), other comorbidities (P < 0.001), anxiety (P < 0.001), and depression (P < 0.001). Conclusion: According to the study’s findings, dyspnea is a common symptom of COPD, and the most important characteristics linked to dyspnea in COPD patients were depression, length of illness, and CAT score.

DOI: 10.5281/zenodo.10958748

Background: Difficult intubation poses a significant challenge in obese patients undergoing general anesthesia, necessitating reliable predictors to identify those at higher risk. This study aims to compare the effectiveness of the ratio of patient height to thyromental distance (HTMD) and the ratio of neck circumference to thyromental distance (NCTMD) as predictors of difficult intubation in obese patients with a BMI >35 undergoing general anesthesia at ESIC Patna, Bihar, from September 2023 to January 2024. Materials and Methods: A prospective comparative study was conducted on 200 obese patients, with a BMI >35, scheduled for elective surgery under general anesthesia. Patients were divided into two groups (n=100 each) based on their HTMD and NCTMD ratios. Demographic data, BMI, HTMD, NCTMD, and Cormack-Lehane (CL) grades during laryngoscopy were recorded. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC-ROC) were calculated for both ratios. Results: The HTMD ratio showed a sensitivity of 78.67%, specificity of 72.33%, PPV of 65.21%, NPV of 82.12%, and an AUC-ROC of 0.80 (95% CI: 0.74-0.86). The NCTMD ratio demonstrated a sensitivity of 82.33%, specificity of 79.67%, PPV of 71.92%, NPV of 86.55%, and an AUC-ROC of 0.84 (95% CI: 0.79-0.89). The mean HTMD ratio was 3.25±0.63, and the mean NCTMD ratio was 0.32±0.05 in patients with difficult intubation (CL grades III and IV). Conclusion: Both the HTMD and NCTMD ratios are valuable predictors of difficult intubation in obese patients with a BMI >35 undergoing general anesthesia. However, the NCTMD ratio demonstrated slightly higher sensitivity, specificity, and AUC-ROC compared to the HTMD ratio. Incorporating either of these ratios into preoperative assessments may aid anesthesiologists in identifying obese patients at higher risk of difficult intubation, thus allowing for better preoperative planning and patient management.

DOI: 10.5281/zenodo.10958772

Background: Glaucoma remains a leading cause of irreversible blindness worldwide, necessitating effective and economical treatment options. Bimatoprost/timolol and dorzolamide/timolol combinations are frequently prescribed for glaucoma management, yet comparative studies on their efficacy, safety, and cost-effectiveness are limited. Materials and Methods: A retrospective comparative study was conducted among glaucoma patients receiving either bimatoprost/timolol or dorzolamide/timolol combination therapy over a 12-month period. Clinical records were reviewed to assess intraocular pressure (IOP) reduction, adverse events, and medication costs. Efficacy was evaluated based on mean IOP reduction from baseline, safety by the occurrence of adverse events, and cost-effectiveness by comparing medication costs per unit of IOP reduction. Results: The study included 150 glaucoma patients, with 75 in each treatment group. Mean baseline IOP was comparable between the bimatoprost/timolol (mean ± SD: 25.4 ± 3.1 mmHg) and dorzolamide/timolol (25.2 ± 2.9 mmHg) groups. Over the 12-month period, both combinations demonstrated significant reductions in mean IOP (bimatoprost/timolol: 6.7 mmHg, dorzolamide/timolol: 5.4 mmHg, p < 0.05). Adverse events were minimal and similar between groups. However, the cost-effectiveness analysis revealed that bimatoprost/timolol was associated with lower medication costs per unit of IOP reduction compared to dorzolamide/timolol. Conclusion: Both bimatoprost/timolol and dorzolamide/timolol combinations effectively lowered IOP in glaucoma patients with comparable safety profiles. However, bimatoprost/timolol demonstrated superior cost-effectiveness, making it a potentially preferred option in resource-constrained settings.

DOI: 10.5281/zenodo.10958823

Background: Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of ascites and needs rapid diagnosis and initiation of antibiotics. Diagnosis of SBP employs cytobacteriological analysis of ascitic fluid which requires good laboratory facilities that can take few hours to 1–2 days to report the results. 24 hr laboratory facilities are not widely available in India. We assessed the utility of the reagent strip (Multistix 10 SG^®) for rapid diagnosis of SBP. Material and Methods: Ours was a prospective, cross-sectional diagnostic accuracy study carried out on patients with cirrhosis of liver with ascites admitted in a tertiary medical college. Multistix 10SG reagent strip test was administered on the ascitic fluid. Cell count was determined by colorimetric scale of reagent strip and was compared with the counting chamber method. Sensitivity, specificity, positive and negative predictive values were evaluated for the reagent strips. Result: Of the 100 cirrhotic patients with ascites, [7 females:93 Males] 52 subjects were diagnosed with SBP by the counting chamber method; as compared to 51 patients detected to have SBP by Multistix 10 SG reagent strip test (3+ positive). In comparison to conventional counting chamber, Method reagent strip 3+ had sensitivity, specificity, positive and negative predictive values 98%,100%, 100% and 97.9%. Conclusion: Multistix 10SG when compared to counting chamber method is very specific and sensitive in diagnosing SBP. It is a fast and convenient diagnostic tool that gives the result in 2 minutes and permits rapid initiation of antibiotic therapy.

DOI: 10.5281/zenodo.10958846

Musculoskeletal diseases (MSDs) are injuries to the muscles, nerves, tendons, joints, cartilage, and spinal discs. The current study sought to analyze the presence of musculoskeletal problems among nurses, as well as their knowledge of low back pain and functional impairment, and to link the knowledge and functional disability to chosen background characteristics. A descriptive cross-sectional research was conducted, with 260 nurses from Sri Ramachandra Hospital in Chennai being polled, and 242 responding. Online survey method was adopted for collecting background data and presence for musculoskeletal disorders from the participants through google forms. The data collection tool consisted of background data, Nordic musculoskeletal Questionnaire. Among 236 nurses, 181, 76.6% were affected with low back pain, among the low back pain nurses 61.8% were reported as 12-month prevalence of low back pain, 48.3% were avoided their routine house hold works, 25.4% were took medical treatment, 61.8% were had trouble in the last 7 days and about 14.8% were had the trouble in last 7 days alone. There was no correlation identified between knowledge and functional impairment and the other characteristics studied. The study’s findings revealed that low back pain was the most common musculoskeletal ailment among nurses. The majority of the nurses had good understanding of low back pain, and modest disability had experience with low back pain. Regular in-service educational programmes on ergonomics practice may help in improvement of knowledge and prevention of disability in their routine professional activities and thereby improves the quality of life, which reflects in quality care.

DOI: 10.5281/zenodo.10958984

Introduction: Radial artery is the smaller terminal branch of brachial artery arising in the cubital fossa, at the level of the neck of radius. This artery is commonly used to do coronary artery angiography, canulation. Aim: To study variations in the origin of radial artery. Various variations in the origin of radial artery were reported earlier, high origin of radial artery and radial artery arising from the axillary artery observed during regular dissections. Material and Methods: Fifty cadavers which includes both male and female were taken embalmed, the cadavers fixed in 10% formalin were dissected. Results: In the present study conducted on 100 upper limbs that means on fifty human adult cadavers each limb is considered as one specimen it is observed that the radial artery is arising from the third part of axillary artery in the axilla from the medial side in 1.upper limb, and in 6 upper limbs the radial artery arising in upper one third of the arm due to high division of the brachial artery. Conclusion: The variations in radial artery may lead to the failure of the transradial approach during surgical and radiological procedures. So the clinicians should have the knowledge of variations while doing any vascular, reconstructive, cardiac, orthopaedic, or radiological manipulations.

DOI: 10.5281/zenodo.10959015

Introduction: Cirrhosis of the liver is a complex and multifaceted condition characterized by the progressive replacement of healthy liver tissue with fibrous scar tissue, resulting in impaired liver function and a myriad of clinical complications. Among these complications, hematological abnormalities play a crucial role in influencing the course and prognosis of the disease. Our study aims to investigate the diverse spectrum of these abnormalities, shedding light on their implications for patient care and management strategies. Material and Method: The study was conducted as a prospective observational cross-sectional analysis at our Department of Surgery in a tertiary care center in Gujarat, India, over a period from June 2022 to May 2023, following ethical approval and participants’ consent. We enrolled 70 cirrhotic liver patients admitted to the in-patient ward, aged 18 years or older, diagnosed with cirrhosis attributed to various etiologies. Using structured data collection, patient information, including hematological parameters, was documented and statistical analysis was performed using SPSS to assess significance among anemia categories. Results: The results revealed distinct demographic patterns among cirrhotic patients, with the majority aged 41-50 years. Gender distribution showed a higher prevalence among males, comprising 61.42% of the cohort. In terms of anemia, macrocytic normochromic anemia was the most prevalent type, followed by microcytic normochromic anemia. Significant variations were observed across hematological parameters among different types of anemia, highlighting differences in red blood cell count, hemoglobin levels, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC). Notably, thrombocytopenia was prevalent in 55.71% of cases, while leukocyte abnormalities varied, with leucopenia and lymphocytosis being the most common. Conclusion: Our study highlights normocytic normochromic anemia as the most prevalent type in cirrhotic patients, with microcytic anemia more common in men. Leucocytosis, lymphopenia, and significant decreases in RBC count and hemoglobin levels were also observed, emphasizing the need for vigilant monitoring and intervention to prevent adverse outcomes.

DOI: 10.5281/zenodo.10959089

Background and Objectives: Helicobacter pylori (H. pylori) infection has been variously implicated in the pathogenesis of gastroesophageal reflux disease (GERD), with conflicting reports on its role. This study aimed to elucidate the association between H. pylori infection and GERD severity, as well as the symptomatic profile of affected patients. Patients and Methods: A retrospective analysis of 240 GERD patients was conducted, assessing H. pylori status, GERD grade based on the Los Angeles classification, and symptom prevalence. Statistical significance was determined using chi-square and Student’s t-test. Results: The prevalence of H. pylori infection among GERD patients was 50%. A significant association was observed between H. pylori positivity and higher GERD grades, with 20.8% of H. pylori positive patients presenting with Grade IV GERD, compared to 12.5% of H. pylori negative patients (p<0.01). Additionally, regurgitation was significantly more common in H. pylori positive patients (75%) compared to those without the infection (50%, p<0.01). Conclusion: H. pylori infection is associated with increased GERD severity and a higher prevalence of regurgitation symptoms, suggesting that the bacterial infection may exacerbate the pathophysiological and symptomatic profile of GERD. These findings highlight the importance of considering H. pylori status in the clinical management of GERD.

DOI: 10.5281/zenodo.10959135

Background: Injecting drug use is a global public health issue and about 15.6 million people inject drugs. Both increasing numbers of people who inject drugs (PWIDs) and increasing trend of HIV positivity amongst them is a great concern. Objectives: To determine the factors behind high prevalence of injecting drug use practices in Karbi Anglong district, Assam and to understand the pattern of drug uses and their risk behaviour. Methodology: This cross-sectional study was conducted amongst PWIDs, availing preventive services at a NGO, Kheroni, Karbi Anglong, using mixed method approach. Total 220 PWIDs were selected using simple random sampling method. Quantitative data were collected using predesigned and pretested schedule. For qualitative assessment, two focus group discussion and five in-depth interviews were conducted. Analysis was done by using SPSS-20. Results: Having adequate knowledge on HIV/AIDS, PWIDs still shared needle. Peer pressure, stress/tension, pleasure, unemployment, influence by family member and easy drugs availability were the underlying factors for high prevalence of injecting drug use in this region. Most commonly used injecting drug was brown sugar followed by Spasmoproxyvon and other drugs. Drug peddlers were the main driving force for attracting new users. Self-reported HIV positivity was 4.5%, which was much higher as compared to previous surveillance studies. Conclusion: Context specific programme strategies may be adopted to control HIV/AIDS spread. Young generation may be covered through sensitization programme to mitigate hazardous methods of injecting drug use.

DOI: 10.5281/zenodo.10959203

Introduction: Nutrition is critical for child growth, especially in the first 1000 days. However, global child undernutrition remains a significant public health issue, particularly in low- and middle-income countries. Children under 5 years are susceptible to severe acute malnutrition (SAM), posing significant health risks. However, current diagnostic methods like weight for age (WFA), mid upper arm circumference (MUAC), and weight for length (WFL) have limitations in accurately identifying SAM in this age range. Our study aims to assess the effectiveness of WFA and MUAC compared to WFL in identifying SAM among children under 5 years. Material and Methods: A retrospective observational study was conducted at a tertiary care centre in Gujarat, comparing weight for age and mid-upper arm circumference with weight for length to identify severe acute malnutrition in children under 5 years. The study spanned from March 2021 to February 2022, with a sample size of 600 children meeting the inclusion criteria of presenting in the vaccination clinic. Anthropometric measurements followed standardized procedures, with MUAC measured using WHO-recommended cutoffs for severe acute malnutrition. Demographic data were collected, and statistical analyses were performed to provide insights into effective screening methods for severe acute malnutrition in this vulnerable age group. Results: In present study involving 600 children, the incidence of severe acute malnutrition (SAM) was 11.3%. Weight for age and mid-upper arm circumference (MUAC) correlated significantly with malnutrition severity, with the majority of SAM children underweight (88.8%) and severely underweight (71.9%). Stunting (length for age) did not differ significantly among malnourished and non-malnourished children (p=0.241), but severe stunting was prevalent among SAM children (78.5%). MUAC <11cm showed significant association with SAM (p<0.001). Majority of SAM children were exclusively breastfed (65.7%), with low birth weight being the most common risk factor (62.8%; p<0.001). Mean anthropometric measurements varied slightly, and MUAC demonstrated fair predictive ability for SAM (AUC=0.774). ROC analysis revealed high sensitivity for MUAC <11cm (86.2%). There was a significant decline in MUAC measurements with decreasing age and cutoff values (p<0.001). Overall, both MUAC <11cm and weight for age were effective in predicting SAM in children under 5 years. Conclusion: MUAC <11cm and weight for age are valuable predictors of severe acute malnutrition in children under 5 years. Current MUAC cutoffs may not effectively identify many at-risk infants and children, advocating for revised cutoffs to better capture vulnerability.

DOI: 10.5281/zenodo.10959721

Anterior chest wall abscess is a rare manifestation of childhood tuberculosis. A case report of tuberculous chest wall abscess in a 1.6 years old healthy girl who had received Bacillus Calmette-Guerin (BCG) vaccination at birth. She developed a localized anterior chest wall mass, which was initially diagnosed as soft tissue neoplasm on the USG and MRI. Pathologic examination of the FNAC specimen revealed chronic granulomatous inflammation and positive acid-fast staining, which confirmed the diagnosis of chest wall tuberculosis infection.  Received a 6-month course of anti-tuberculous treatment. The chest wall lesion was resolved without the need for surgery. In conclusion, tuberculosis should be ruled outin children with undiagnosed chest wall lesions, especially in endemic areas, even if they have been vaccinated with BCG. Adequate anti-tuberculosis treatment can result in a complete recovery.

DOI: 10.5281/zenodo.10959737

Introduction: Asthma is a chronic respiratory disorder influenced by both genetic and environmental factors. During the same time span, intrauterine environmental factors will shape the fingerprint’s orientation and design. This study aims to determine if there are any differences in fingerprint patterns between individuals with bronchial asthma and healthy controls. Method: A case-control study of 460 participants aged 5 to 50 years, comprising 230 bronchial asthma patients and 230 healthy individuals were conducted. The fingerprints of all participants were obtained using the Indian Ink method. Statistical analysis was conducted using SPSS Version 20 and significance was tested using the Chi-square test (p < 0.05). Result: The analysis of statistical data has revealed significant differences in the distribution of fingertip patterns between bronchial asthma patients and controls across all fingers: first finger (χ2 = 110.87, p < 0.00001), second finger (χ2 = 56.73, p < 0.00001), third finger (χ2 = 25.45, p < 0.00001), fourth finger (χ2 = 18.97, p < 0.000076), and fifth finger (χ2 = 11.3, p = 0.0035). These findings indicate a clear relationship between dermatoglyphic patterns and bronchial asthma, suggesting potential diagnostic and prognostic implications. Conclusion: Bronchial Asthma patients consistently displayed fewer arch patterns but more loop and whorl patterns across all fingers compared to controls. These findings suggest a link between bronchial asthma and fingerprint patterns, indicating the potential of dermatoglyphic analysis as a non-invasive means of asthma risk assessment.

DOI: 10.5281/zenodo.10959753

Background:  Distal radius fractures are among the commonest upper extremity fracture. Aims & Objectives: (1) To assess the socio-demographic & health profile of the patients. (2) To assess the aetiology, types of fracture and post-operative findings. Methods and Material: The study participants were confirmed DRF patients admitted at orthopaedics department of civil hospital- Junagadh and few private tertiary hospitals. A cross-sectional study was conducted during the period from July to December 2023. As per the predefined inclusion & exclusion criteria, a total 117 patients were taken for the study. Informed consent of participants was taken. Specially designed performa was prepared for the data collection. Results: Mean age of distal radius fractures patients was 46.4±12.2. Majority (60.7%) patients were males. Among the half of the patients, reasons for the DRF was road traffic accident. In Frykman DRF classification, majority (33%) of the patients were belonged to type-3. AO classification shows majority of DRF were type-B (52%). Post-operative mean radial shortening (in mm) was 0.5±0.2. Conclusions:  A very few of the patients had radial shortening ≥2 mm, which was good post-operative outcome. Types of DRF, choice of surgical procedures with operative skills are some of the key factors for better post-operative outcome.

DOI: 10.5281/zenodo.10959773

Introduction: Smartphones have become a part and parcel of everyone’s life, from rich to poor it has made its home in everyone’s pocket, school going adolescents are no exception. However, due to unchecked availability of its services it has the potential to cause behavioral addiction. There is paucity of data regarding the extent of smartphone addiction among adolescents of different age groups. Objective: To study the smart phone addiction among school going adolescent. To evaluate effect of smart phone addiction among adolescents. Study design: A cross sectional questionnaire-based survey was done among 2100 school going adolescents of age groups 10 to 19 years satisfying the inclusion criteria. Smart Phone addiction scale was used. Additional data regarding their socio-demographic profile were also collected. Results: Overall 20% were found to be addicted and 53.4% were prone to getting addicted to smartphones, with 17 to 19 years of age contributing 52% of addicted children. It was observed that the most common health problem associated with smart phone is dry eyes (27%), followed by pain in neck, wrist and back (16%), and followed by chronic tiredness (11%), although study revealed that 38% had no health problem. Conclusion: Addiction was more in 17-19 years of age group and in those children whose parents had higher education, living in small family, having <2 children, upper socio economic. The most common health problem associated with addiction was dry eye followed by pain in neck, wrist and back.

DOI: 10.5281/zenodo.10959817

Introduction: Preterm neonates are unable to feed directly from the breast and have feeding difficulties due to lack of coordination between respiration and sucking-swallowing. Nifty cup is an affordable and simple feeding cup designed to optimize feeding in preterm neonates with breastfeeding difficulties. Aim: The aim of the study was to assess the acceptability of Nifty cup among care providers in the feeding of preterm neonates in resource poor countries. Method: A randomized controlled study was done in 2 groups of preterm neonates fed by Nifty Cup(test group) and conventional Katori-spoon (control group). A pre-validated questionnaire was used to assess the caregiver’s (mothers/nurses) perception of ease and comfort of use of the feeding tools, spillage, ability to control pace of feeding, time taken in feeding, easy maintenance of the feeding tools and acceptability of the feeding methods. the grading of acceptability was considered as good (+3), fair (+2) and not acceptable (+1). Result: Care providers found Nifty cup to be more acceptable as compared to Katori spoon feeding (p-value <0.05. However, there was no significant difference in growth velocity of the neonates between Nifty cup and Katori spoon groups. Conclusion: Nifty cup was more acceptable to care providers than traditional Katori-spoon for feeding of preterm neonates.

DOI: 10.5281/zenodo.10959873

Introduction: Anterior Cruciate Ligament (ACL) injury is one of the common sports injuries encountered. It is a very important ligament in knee which contributes to the stability of the knee joint. Reconstructing ACL is essential to prevent early onset osteoarthritis of the knee joint as well as to have better functional outcome. There are numerous autograft options like bone-patellar tendon-bone graft, Hamstring graft and peroneus longus graft with their own merits and demerits. The present study is intended to study the functional outcome following ACL reconstruction with quadrupled hamstring graft.Methods and Materials:  Patients with ACL injury and those who have met inclusion and exclusion criteria are included in the study. After thorough pre-op evaluation, the patients are treated with reconstruction of ACL with quadrupled hamstring graft. They are assessed pre-operatively and post-operatively up to 9 months by doing Lachman test, Anterior Drawer test, Pivot shift test and few functional scores like Lysholm knee score and IKDC subjective knee evaluation score. Thus, the functional outcome of knee is assessed. Results: Among the 32 patients, who are included in the study, 28 are males. Right limbs are more commonly involved. In this study, RTA is the most common mechanism of injury. About 10 cases are also associated with meniscal injuries. The average IKDC score among the isolated ACL injury cases is 88.6 and in those associated with meniscal injuries is 86.3. About 75.4% of patients showed better outcome in the study. Conclusion: Anatomical reconstruction of ACL is key for better functional outcomes in knees with ACL injury. Better functional outcome is seen in isolated ACL injuries compared to ACL injuries with meniscal involvement. ACL reconstruction with quadrupled hamstring graft is one of the reliable methods which provides better results. It is not associated with much donor site morbidity.

DOI: 10.5281/zenodo.10960449

Background: Medical research is fundamental to advancing healthcare, yet medical students often encounter various barriers that affect their engagement in research activities. This study aims to investigate the knowledge, attitudes, and barriers related to research among medical students. Understanding these factors will be crucial for enhancing research participation among future healthcare professionals. This study aims to find out the current state of research knowledge among medical students. Methods: A cross sectional study was conducted among students. A questionnaire-based interview was conducted to collect data from medical student using purposive samplings. A total of 300 participants completed a structured questionnaire. All the data were collected through google form and downloaded in excel format for analysis. Results: The results of the study found that 74% medical students had knowledge towards research, but there were gaps in their knowledge and skills necessary for conducting research effectively. The mean age was 23.45 and age range between 22-25 years. Majority of them were male compare to female. More than 70% adequate knowledge but only 21% had attitude towards research. Moreover, several barriers were identified, including lack of time, limited research facility, and a lack of mentorship. These barriers delayed students from actively participating in research projects. Furthermore, it emphasizes the importance of providing mentorship and support systems to address the identified barriers. By addressing these issues, medical colleges can promote knowledge on research to students. Conclusion: This study results shows that even though many students had a good knowledge about research only few students have participated in the research projects. This research through light on the existing challenges and opportunities in research among medical students. It offers valuable insights into the knowledge, attitudes, and barriers on research.

DOI: 10.5281/zenodo.10960661

Objectives: Adnexal masses (i.e. masses of the ovary and/or fallopian tube or surrounding tissues) are commonly encountered by gynaecologists and often present both diagnostic and management challenges. This is partly due to the fact that the most of the adnexal masses that are identified represent benign entities that do not necessarily require active management, yet a small subset will represent malignancy that requires both timely and appropriate surgical intervention for optimal outcome. The majority of adnexal masses are unintentionally discovered during physical examinations or pelvic imaging procedures. Less commonly, a mass can become symptomatic and thus the management decisions are influenced by the age, parity, family history and vitals of the patient. This study highlights the varied nature of the adnexal mass, analyse the clinical features, imaging, management and histopathology in the patients from reproductive to post-menopausal age group in 1 year. Methods: This is a case series on adnexal masses reported from the Department of Obstetrics and Gynaecology, Government Medical College and Rajindra Hospital, Patiala, Punjab, India from 1 May, 2022 to 31 May, 2023, who underwent medical and/or surgical treatment and followed by the histopathological examination of specimens. Results: 16 patients with adnexal masses were included in the study. 7 patients had suspicion of malignancy in radiological investigations but only 4 cases reported to be malignant on histopathology that were started on chemotherapy. Tubercular pathologies were dealt with ATT. Conclusion: Majority of the adnexal masses present with pain abdomen and turn out to be benign entities. Radiological investigations may suggest malignancy in some but histopathology is the gold standard investigation.

DOI: 10.5281/zenodo.10960719

Subtotal and total thyroidectomy are the surgeries commonly performed for benign thyroid disorders. Total thyroidectomy was not routinely performed in the past as it was believed that complications like hypoparathyroidism and recurrent laryngeal nerve injury are more common after total thyroidectomy. However subtotal thyroidectomy is associated with recurrence of the disease which warrants a second surgery. Reoperation has higher rate of above mentioned complications. The aim of our study was to compare the post operative complications in patients undergoing subtotal thyroidectomy with those undergoing total thyroidectomy. Our study involved 140 patients out of which 37 and 103 patients underwent subtotal and total thyroidectomy respectively. Post operative complications, mainly hypoparathyroidism and recurrent laryngeal nerve injury were compared between the study groups. The incidence of complications were almost similar in both the groups and was slightly higher in patients with total thyroidectomy. As chances of recurrence of disease is high in patients undergoing subtotal thyroidectomy and nil in total thyroidectomy group, we came to the conclusion that total thyroidectomy can be considered as a suitable and safe operative procedure for benign thyroid diseases.

DOI: 10.5281/zenodo.10960813

Background: Umbilical and paraumbilical hernias are common conditions requiring surgical intervention. This study aims to compare the outcomes of laparoscopic and open repair methods for these hernias. Methods: A prospective observational study was conducted with 103 patients undergoing hernia repair, divided into laparoscopic (n=48) and open repair (n=55) groups. Outcomes measured included operative time, postoperative pain, hospital stay, return to normal activities, complications, and recurrence rates. Results: The laparoscopic group had a significantly longer mean operative time (90.83 ± 15.2 minutes) compared to the open repair group (52.91 ± 10.5 minutes, P<0.001). However, laparoscopic repair was associated with significantly lower postoperative pain scores at 6 hours (3.85 ± 0.989 vs. 4.95 ± 1.056, P<0.001) and 24 hours (2.04 ± 0.544 vs. 2.82 ± 0.645, P<0.001), shorter hospital stays (2.35 days vs. 3.65 days, P=0.001), and quicker return to normal activity (2.79 weeks vs. 3.85 weeks, P<0.001). Complication rates were lower in the laparoscopic group (10.42% vs. 36.36%, P=0.02), with no significant difference in recurrence rates between the groups (2.08% vs. 7.27%, P=0.227). Conclusion: Laparoscopic repair for umbilical and paraumbilical hernias offers significant benefits over open repair, including reduced postoperative pain, shorter hospitalization, and faster recovery, without compromising safety or efficacy.

DOI: 10.5281/zenodo.10961025

Introduction: Fever is the main reason children attend the paediatric emergency room. When young infants have feverish infections, it can be challenging to determine the underlying reason. A general viral infection is often considered the cause of feverish sickness in the absence of specific focused symptoms. UTIs are a common cause of fever without concentration, especially in children under two years old. Pathogen invasion of the urinary system is the cause of a urinary tract infection (UTI). The upper or lower tract may be affected by an infection, depending on whether it is in the kidney, bladder, or urethra. A child’s typical urinary architecture and physiology, which includes complete emptying at regular, adequate intervals and unidirectional urinary tract flow, should protect them from urinary tract infections. Material and Method: The paediatric department of SCBMCH & SVPPGIP, Cuttack, conducted the current study from December 2015 to November 2017, a span of 24 months. Research design: hospital-based prospective case control study. Selection of Patients: both outside and within medical facilities The investigation examined children with urinary tract infections (UTTIs) between the ages of 0 and 14 who were treated by the paediatric department at SCBMCH & SVPPGIP, Cuttack over a 24-month period ending in November 2017. To choose the cases for the research, a purposive sampling strategy was used. Children who have symptoms of UTI and positive urine culture (UTI) are considered cases. Age-matched kids who were selected from a group at a follow-up appointment for a previous febrile treatment serve as the comparison and control groups. Result: The study included 270 children in all who met the inclusion criteria. Out of the total of 270 youngsters, 135 had a positive urine culture (case), whereas the remaining 135 had a negative urine culture type (control). Data were gathered using a pre-made proforma. A systematic questionnaire was used to interview parents and children about urinary tract infections. The following information was recorded: prior history of UTI, worm infestation, bowel habits, circumcision and phimosis in male children, age, sex, anthropometry (weight and height), socioeconomic position, and other predisposing risk factors. Conclusion: Urinary tract infections are frequent in children and can result in long-term morbidity.
The following findings are the result of the investigation: UTIs are more common in infants. It is more common for females than for males to have a UTI. The afflicted children’s MALE: FEMALE ratio was 1.27 for older children and 1.1:1 for infants. Most children with UTIs fall within Classes V and IV of the Kuppuswamy Socioeconomic Scale. Fever was the predominant indicator of a UTI. There were also other nonspecific symptoms noted, such as burning micturition, low appetite, vomiting, discomfort in the abdomen, worm infestation, and rising frequency was shown to be closely related to UTI, with worm infestations present in 25% of the children in the UTI group.

DOI: 10.5281/zenodo.10961572

Background: Asthma is a prevalent hyperactive airway disease with physical and emotional impact. Asthma is a prevalent non-communicable disease identified by chronic airway inflammation affecting children and adults worldwide. Differential symptoms are wheezing, dyspnea, chest discomfort, and persistent cough in addition to airflow limitation, especially at night and in the early morning. The pattern and intensity of the symptoms and airflow limitation vary over time, with exercise, allergen, and exposure to irritants, weather changes, and respiratory infections, leading to exacerbation of asthma. Although asthma cannot be cured, exacerbations can be prevented by adequate patient counseling and proper management. Severe asthma is associated with considerable health-related quality of life (HRQoL). The aim of this study is to assess the quality of life through physical, emotional, social and occupational aspects and evaluate the factors affecting HRQoL in patients with asthma. Materials and Methods: A total of 90 adolescents, aged 10-19 years old and clinically diagnosed with asthma and classified according to Guidelines by the Global Initiative for Asthma in adolescents (GINA) [20], were recruited at the Pediatric Asthma Clinic of the Hospital over a period of 1 year. Patients were randomly recruited at the time of their visit to the clinic, during a period spanning 10 months. All patients were evaluated by pulmonologists, who confirmed a documented clinical history of asthma and follow-up visits, and were classified into 4 asthma severity groups according to GINA guidelines: Intermittent, mild, moderate and severe ; because of the random recruitment, no effort was done to equalize the size’s groups. Criteria of eligibility were: a) Be a Indian citizen; b) Clinical history of at least one year of asthma; c) Aged from 10 to 19 years old. Result: 90 asthmatic children (mean age12.98± 1.7, M:F = 60:30) were evaluated. All 3 domains (activity limitation, symptoms, and emotion) of QOL affected equally and all domains had shown significant improvement after 4 weeks of standard asthma treatment. Children with severe asthma had activity limitation (P = 0.073) and no improvement in emotional score (P = 0.057). Children with uncontrolled asthma showed deterioration in QOL (P = 0.50). There was no difference in QOL among urban and rural residing children, family history of asthma/allergy, and socioeconomic status of parents (P > 0.05). Conclusion: Although the quality of life and anxiety scores of children with asthma did not differ from the control group, good asthma control in adolescents with asthma may improve QoL. Adolescence is a sensitive age group, and requires meticulous consideration by caregivers. The parents’ awareness of anxiety and other psychological symptoms may help them to cope with the challenges.

DOI: 10.5281/zenodo.10961641

Background: Glaucoma is a group of eye diseases characterized by bilateral optic nerve neuropathy and atrophy of the optic nerve disc. The drug timolol is a non-selective β blocker that has no local anesthesia but stabilizes the membrane, and dorzolamide lowers the intraocular pressure (IOP) and enhances the blood flow. Method: 80 adults’ patients with open angle glaucoma were studied. 40 patients were randomly selected as group-I (IOP between 20 to 30 mm Hg) 40 group-II (IOP between 31 to 40) according to their IOP., Further, both groups were divided into IA (20), IB (20), IIA (20), IIB (20), Groups IA and IIA were administered Dor-zolamide 2% and one drop thrice daily in both eyes. Groups IB and IIB were administered 0.5% Timolol; one drop was administered twice daily in both eyes. General examination includes examination by torch light. Slit-lamp, distant visual acuity tested by illuminated Snellen’s chart, Schistz tonometry, gonioscopy, fundus exam-ination, and field analysis by the octopus auto-field analyzer. Ophthalmoscopy and slit-light biomicroscopy were used. Results: Comparison of IOP at 24 weeks has significant p values (p<0.001). In comparison of IOP reduction by different drugs, Dorzolamide 2% had a significant p value (p<0.001). In comparison of IOP reduction by the same drug in different groups, Dorzolamide has a significant p value. But the effects of both drugs on blood pressure and heart rate had a significant p value (p<0.001). Conclusion: During the comparative study, it was observed that dorzolamide is well tolerated, efficacious for reducing IOP, and has a low allergic response as compared to timolol.

DOI: 10.5281/zenodo.10961704

Background: As the clavicle lies horizontally in the body, it is more susceptible to fracture. As it does not have a medullary cavity for the union of a mid-clavicular fracture, new techniques are required. Method: Out of 60 patients with mid-clavicular fractures, 30 were treated with TENS and 30 with plating. A routine blood examination and an ECG and radiological study were carried out, and general anesthesia was given. Results: Mean blood loss, timing for surgery, and size of wound were quite low in the nailing technique as compared to the plating technique, and the p value was highly significant (p<0.00). Surgical complications were also the least common with nailing techniques. The rate of union was 100% in both techniques. The mean dash square rate in the 1^st, 2^nd, and 6^th months was highly significant in nailing technique (p<0.001). Conclusion: Although both techniques have a 100% union rate of fracture and are equally effective in treating displaced mid-clavicular fractures, Owing to the least post-surgical complications, the TENS technique is preferred over the plating technique.

DOI: 10.5281/zenodo.10961784

Background: Regional anesthesia is the preferred technique for endo-urological procedures. Both anesthetics, i.e., levobupivacaine and ropivacaine, have the same clinical profile. Hence, a safe and effective anesthetic has to be found. Method: 77 patients admitted for endoscopic urologic procedures were studied. Out of 77, 37 patients were administered ropivacaine (group R) and 40 were administered levobupivacaine (group L). The motor and sensory blocks were assessed by using the pin-prick method with a 23G or 25G needle in the mid-clavicular line. The intra-operative blood pressure, heart rate, and SPO2 were recorded and compared in both groups. Move-over side effects were also recorded and compared. Results: Sensory and motor blockade duration have a significant p value (p<0.001). Conclusion: Both anesthetic agents have similar clinical profiles, but Ropivacaine group had rapid sensory and motor black. However, both anesthetic agents are ideal alternatives to Bupivacaine.

DOI: 10.5281/zenodo.10961950

Background: Bacteria that are resistant to medicines make it harder to treat orthopaedic illnesses. Some types of these illnesses are osteomyelitis, artificial joint infections (PJIs), and septic arthritis. To make sure that patients get the best care and the best results, it is important to know how common and changing drug resistance is in orthopaedic infections. Method: Two hundred bacterial strains linked to orthopaedic diseases were looked at in this study that looked back in time. To get demographic information and the results of drug resistance tests, the scientists searched through a lot of electronic health records and lab databases. The cause of drug resistance was found, and statistical analysis was used to look closely at its trends. Result: 60% of the pathogens identified were produced by PJIs, with Staphylococcus aureus being the most prevalent. Resistance to vancomycin and MRSA was detected in 12.5% and 5.5% of gram-positive bacteria, respectively. Resistance to fluoroquinolone, clindamycin, gentamicin, and trimethoprim/sulfamethoxazole was estimated to be 20–40% based on the data. Conclusion: Findings from this study show that a lot of antibiotic-resistant infections happen in orthopaedic illnesses, but a lot of antibiotic-resistant infections happen in patient-related infections (PJIs). The fact that some bacteria are resistant to methicillin and vancomycin makes it hard to use antibiotics as a general treatment in medical settings. Additionally, this shows how important it is to be careful when giving antibiotics and take precautions to lower the chance of infection spread. More study is needed to reach the goals of learning more about antibiotic resistance and creating personalised treatments for orthopaedic diseases that are immune to multiple drugs.

DOI: 10.5281/zenodo.10961983

Introduction: Cataract is the most common cause of reversible blindness, and surgery is the only intervention available till now. In developing countries like India MSICS is the most favoured method. Astigmatism may be an error either of curvature, cantering or due to refractive index. Site and size of scleral incisions are the factors which influence the SIA. We conducted this study with aim of comparing the Surgically Induced Astimatism (SIA) in small incision cataract surgery by Superior, Supero-Temporal and Temporal incision. Material & Methods: Total 150 cases were included. Pre-operative and post-operative findings were noted. Astigmatism found is examined after 1^st day, 7^th day, 30^th day and 60^th day. Results: In our study on 150 eyes in MSICS (50 eyes in each group), we found that there is significantly less SIA in Supero-temporal and Temporal approaches as compared to Superior approach of incisions. Superotemporal and Temporal incision group patients get BCVA 6/9 or 6/6 with less amount of cylindrical number in comparison to Superior incision group. Conclusion: In spite of the fact that the Superotemporal incision induces higher SIA than the Temporal approach but the difference between the both is not significant, the disadvantages associated with temporal incision are more. So, we recommend Superotemporal approach better for Manual SICS over the Superior and Temporal incisions.

DOI: 10.5281/zenodo.10962026

Psyllium husk obtained from plantago ovata is high in both soluble fiber (70%) and insoluble fiber (30%). Fiber improves the control of blood glucose and delays glucose absorption. The purpose of this study was to determine glycemic index of Amaranthus chapatti and to evaluate effect of psyllium supplimentation on glycemic response of Amaranthus chapatti. Subjects were randomly selected from Jhalawar Medical College, Jhalawar to participate in a case-controlled study; ninety six subjects were included in this study, subjects were given diet counseling before the study. Amaranthus chapattis were given in 50 grams of digestible available carbohydrates as test diet-1. Same Amaranthus chapatties were given along with 5 gm of psyllium husk as test diet-2. The reference food was a solution in water (250 ml) containing 50 g glucose. In the morning, 5 times the blood was collected – on an empty stomach and 30, 60, 90 and 120 minutes after eating for both test diets and reference food for three consecutive days in healthy controls and in patients with type II diabetes. Difference in Glycemic indices of Amaranthus chapatti 95.4 + 6.6  is statistically highly significant with Amaranthus chapattis with psyllium husk 87.4 + 6.2 for healthy subjects(P < 0.0001)  and for  diabetic patients Amaranthus chapatti (GI- 95.9 +1.6) and for Amaranthus chapatti with psyllium husk  GI – 90.8 +1.3 (P < 0.0001). Our results demonstrate values of glycemic indices for Amaranthus chapatti and evaluate effect of  psyllium husk on glycemic response, addition of 5 gm of psyllium husk to test diets significantly decrease the value of glycemic index in both the groups.

DOI: 10.5281/zenodo.10962044

Background: This study was conducted to categorise the spectrum of salivary gland lesions according to the Milan system for reporting salivary gland cytopathology, establish a correlation between pre-operative cytopathology and post-operative histopathology and highlight the diagnostic pitfalls in cases of cyto-histo miscorrelation. Methods: This was a hospital-based study conducted among 57 patients who underwent FNAC of salivary gland lesions at the Department of Pathology, M.K.C.G Medical College and Hospital, Berhampur, from November 2019 to November 2021, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: 33 patients were followed up for histopathological studies. Upon categorization of all the salivary gland lesion aspirates into 7 categories of MSRSGC, we found the maximum number of cases in category IVA i.e. neoplasm: benign accounting for 38.6% of the cases, followed by category II (non-neoplastic) with 31.58% of the cases. The least number of cases were placed in categories I (non-diagnostic), IVB (SUMP) and V (suspicious for malignancy) with 1.75% of the cases in each of the categories. Conclusion: The high sensitivity, specificity, positive predictive value, negative predictive value of FNAC when reported according to “The Milan System for reporting salivary gland cytopathology” confirm that preoperative cytology is a quick and reliable diagnostic technique for rapid and early diagnosis and we also conclude that it is a simple and cost effective tool suitable for developing countries like India.

DOI: 10.5281/zenodo.10962050

Background: This study was conducted to ascertain the cosmetic outcome and recurrence rate in patients following the P.E.R.F.E.C.T. (Pterygium Extended Removal Followed by Extended Conjunctival Transplant) surgical procedure. Methods: This hospital-based prospective study was carried out over a 2-year period, from December 2020 to November 2022, among 50 patients with primary pterygium who were attending the Ophthalmology Outpatient Department at Regional Eye Hospital, Kurnool. The study was approved by the institutional ethics committee, and the participants’ written informed consent was obtained. Results: In 60% of cases, pterygium is of the primary progressive type; in 26% of cases, it is of the grade 3 primary progressive type. In 14.5 instances, the primary atrophic type is observed. With a mean size of 3.4 mm, grade 2 pterygium is more common than grade 3 pterygium. The majority of patients had cosmesis, visual abnormalities, redness, and pain. After 6 weeks, the overall mean astigmatism (for grades 2 and 3) was 2.08 +/- 1.36 D postoperatively, indicating a considerable reduction in astigmatism following excision. Preoperatively, it was -3.43 +/- 1.95 D. Based on the Hirst web-based grading system, 46% of patients receive a normal score, 30% receive an exceptional grade, and 18% receive a good grade. This indicates that the majority of patients are satisfied with their cosmetic look following P.E.R.F.E.C.T. surgery. With the exception of minor buttonhole flaws, there were no significant intraoperative problems. Following surgery, 56% of patients reported pain, discomfort, and redness. Conclusion: According to a web-based grading system provided by Hirst L. W. et al., 95% of patients who had P.E.R.F.E.C.T. for pterygium had cosmetic appearances of normal, excellent and good.

DOI: 10.5281/zenodo.10962481

Background: The ongoing worldwide Corona virus Disease 2019 (COVID-19) pandemic has posed a huge threat to global public health. Numerous inflammatory markers are elevated in patients with severe disease relative to patients with milder conditions. Interleukin-6 (IL-6) was identified as potential inflammatory biomarkers in Covid-19 pandemic. IL-6 is a cytokine featuring pleiotropic activity. It induces synthesis of acute phase proteins such as C-reactive protein, serum amyloid A, fibrinogen and hepcidin in hepatocytes.  Interleukin-6 is an early biomarker of infection and inflammation. IL-6 is one of the main mediators of inflammatory and immune response initiated by infection and injury in lungs. Aims: To correlate serum IL-6 level in covid-19 patients and its relationship with severity of the disease. Methodology: The study was conducted on three groups mild (N=30), moderate (N=30) and severe (N=30) covid-19 positive patients. Age matched covid-19 negative as controls (N=30) also recruited for this study. Serum IL-6 levels in covid-19 patients were measured by using an immune-enzymatic chemiluminescence assay. Results: We found that serum IL-6 levels were significantly increased in covid-19 patient as compared to normal healthy controls. Our result shows that serum IL-6 levels were increased as disease progress from mild to severe condition of Covid-19 patients. Conclusions: Serum IL-6 increased in COVID-19 due to enhanced cell mediate immune response, infection and tissue damage in lungs. Our results suggest that monitoring inflammatory markers may serve as an early warning system for progression to severe COVID-19.

DOI: 10.5281/zenodo.10962495

Introduction: Acute renal failure (ARF) represents a sudden impairment in renal function occurring rapidly over hours to days. It is categorized into prerenal, renal, and post-renal aetiologies, with prerenal ARF being predominant in children. Pediatric ARF remains a significant cause of morbidity and mortality, particularly in hospitalized patients, with reported mortality rates ranging from 29% to 46%. Arterial blood gas (ABG) analysis serves as a vital tool in assessing oxygenation, ventilation, and acid-base status, with interpretations crucial for managing critically ill patients, especially those with chronic kidney disease (CKD) who frequently encounter acid-base disorders. Objectives: This research primarily aims to analyze the clinicoepidemiological profile of AKI in children and analyze various ABG abnormalities in these patients. Materials and Methodology: The Present study included Children diagnosed with acute renal failure attending Department of pediatrics, Govt. Medical College, Kota, Rajasthan From March, 2021 to February, 2022. It was a prospective analytical study. A predesigned, pre-tested, semi-structured questionnaire was used for data collection. Results: The mean age of children with AKI was approximately 5.53 years, with a majority being males (60.9%). Perinatal asphyxia emerged as the most common underlying cause (31.3%), followed by sepsis, dehydration, lower respiratory tract infections (LRTI), glomerulonephritis, and polytrauma. Upon admission, common clinical presentations included fever, oliguria, edema, vomiting, and anemia. Acidosis was prevalent in almost all AKI cases. Hyperkalemia, hyponatremia, and elevated chloride levels were the most common electrolyte abnormalities observed. Mortality rates were highest in Grade III AKI patients, especially in those with oliguria, edema, and requiring mechanical ventilation. Conclusion: This study contributes valuable insights into pediatric AKI cases highlighting the importance of early recognition of AKI  in pediatric population by means of taking appropriate clinical history, identifying various risk factors, utilizing the ABG analysis and early biomarkers( if available). Recommendations: Study advocates for the routine use of ABG analysis as a bedside tool to assess acid-base status promptly.

DOI: 10.5281/zenodo.10962505

Background: Post-surgical wound infections contribute substantially to the overall global burden of healthcare- associated infections (HAIs). These infections often lead to prolonged hospital stays, increased morbidity, and higher treatment costs, placing a strain on healthcare resources. The emergence of antimicrobial-resistant strains of bacteria in post-surgical wound infections poses a global threat. Hence to address the limited data on post-surgical wound infections, we conducted this research to determine the prevalence and antimicrobial susceptibility patterns of aerobic bacteria in post-surgical wound infected patients in Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India. Methods: Hospital based descriptive cross sectional study was carried-out in 693 patients who had undergone surgery in general surgery and showed symptoms of infection clinically from January to December 2023. Standard bacteriological methods were used for bacterial isolation and their antimicrobial susceptibility pattern. Results: A total of 693 patients (435 males and 258 female) with clinical signs of post- surgical wound infections were enrolled. The age of the patients ranged from 11–80 years (with mean 33.24 ± 18.09 years). Out of the 693 wound swabs taken, 81 (11.68%) were culture positive. Out of these bacterial isolates, the predominant isolates were Pseudomonas aeruginosa (28) 28.39%, Coagulase negative staphylococci (CoNS) were 17 (20.98%), Escherichia coli (15) 18.51%, Staphylococcus aureus 13 (16.09%), Klebsiella species 08 (9.87%) and Proteus spp were 05 (9.17%). Bacterial isolates of 43/81 (53.08%) of Gram negative and 30/30 (100%) of Gram positive were sensitive to Gentamicin, Amikacin, carbapenems (100%), linezolid and Vancomycin, respectively. The cumulative incidence rate of post-surgical wound infection was 11.68%. The analysis defined four variables significantly associated with post-surgical wound infection i.e. middle or elderly age, male gender, diabetes mellitus, anemia, smoking, contaminated/dirty wound, hypertension and emergency surgery. Conclusion: Preventing post-operative surgical site infections is a crucial aspect of patient care. Implementing effective control measures can significantly reduce the risk of infections. Implement proper postoperative wound care, including monitoring for signs of infection such as redness, swelling, warmth, and discharge. Follows the general infection control practices e.g. hand, environment hygiene, proper surgical instrument sterilization, staff as well as patient education.

DOI: 10.5281/zenodo.10962526

Introduction: Palpable breast lumps are quite common which can be benign or malignant. Carcinoma breast is the second most common cancer after cervical cancer. Fine needle aspiration cytology (FNAC) is a minimally invasive, rapid, reliable and cost-effective outdoor procedure to provide effective diagnosis and way to further planning of treatment without need for biopsy. Objectives of Study: To study the cytomorphological spectrum of palpable breast lesions to aid in diagnosis and treatment. Material and Methods: A prospective study undertaken on 150 patients who had presented with Palpable Breast Lump at the Department of Pathology for a period of 6 months. Results: FNAC was performed in 150 cases which showed age range of 10-80 years. Wide varieties of lesion were seen which included inflammatory, benign and malignant lesions. Benign neoplasms were seen in majority of cases 64 (42.67%) followed by malignant lesions 22 (14.67%). Fibroadenoma was the commonest benign neoplasm 52 (34.67%) cases in our study. Duct carcinoma was the commonest malignant breast tumour 18 (12%) cases in our study. Conclusion: FNAC is a rapid, economical, and reliable tool for the diagnosis of palpable breast lesions. FNAC provides useful information in the management of the lesions and prevents unnecessary surgery in cases of non-neoplastic lesions. Breast lesions can be classified into benign, malignant, atypical, suspicious, and unsatisfactory categories. Benign breast lesions are common in comparison to malignant lesions.

DOI: 10.5281/zenodo.10962537

Introduction: Lymph node enlargement is frequent presentation in all age groups with a wide spectrum of diseases, ranging from infections to malignancy. Therefore, management of cases depends on lymph node. pathology, which can be studied by collecting material through fine needle aspiration method that can be used as an outpatient procedure. Objectives of Study: To study the cytomorphological spectrum of enlarged lymph nodes to aid in diagnosis and treatment. Material and Methods: A prospective study undertaken on 205 patients who had presented with lymph node enlargement at the Department of Pathology for a period of 6 months. Results: Most common lesion observed in our study was reactive lymphadenitis, followed by granulomatous lymphadenitis, metastatic malignancies, necrotizing lymphadenitis, acute suppurative lymphadenitis, and lymphomas respectively. Conclusion: Lymphadenopathy is most commonly superficial, palpable, and therefore easily accessible to sampling by palpation or ultrasound guided FNA, which usually results in a fast, reliable, and relatively inexpensive diagnosis. In the current study, reactive lymphadenitis was recorded as the most common presentation of lymphadenopathy in the cervical region. It not only confirms the presence of metastatic diseases but also, in most cases, gives the clue regarding the origin of the primary tumour.

DOI: 10.5281/zenodo.10962556

Chronic dacryocystitis is   the indication for   Endoscopic Dacryocystorhinostomy. The surgical procedure of diversion of lacrimal flow within nasal cavity through an artificial fistula made at the level of lacrimal sac is called dacryocystorhinostomy. Initially external DCR gained popularity largely due to simplicity of technique and complexity of endonasal approaches. Recently after the advent of endoscopes, endonasal DCR regained popularity. This is largely due to technical advances in the rhinological instrumentations and endoscopes. In the study we comprehensively analyze in detail about the dacryocystitis disease pattern and its endonasal endoscopic surgical management with its 6 months follow up All the patients underwent dacryocystorhinostomy and were evaluated clinically for the subjective and objective relief of symptoms at three and six months respectively. The study comprises the analysis of 50 patients of chronic dacryocystitis who underwent endonasal endoscopic DCR within a period of 4 year.

DOI: 10.5281/zenodo.10962571

Background: Paediatric neck masses are a common disease entity in Otorhinolaryngology ranging from benign to malignant conditions. Most neck masses in pediatric patients are either inflammatory lesions or benign tumors but a considerable portion of pediatric neck mass constitutes malignant tumors also. To avoid fatal complications, paediatric neck masses need early diagnosis and prompt management. Paediatric neck mass can be divided into inflammatory, developmental (congenital), and tumorous lesions (either benign or malignant). Materials and Method: A retrospective observational study including patients less than 12 years of age attending the outpatient department and those admitted to the ward in the department of Otorhinolaryngology, Assam Medical College and Hospital, Dibrugarh, Assam between August 2022 to August 2023, where neck masses were studied concerning age and sex, size and consistency of the mass and aetiology of the mass based on Clinical, Radiological, Haemalogical, Microbiological and Pathological (FNAC and HPE) correlation. Results:  A total of 60 patients were studied where Males with neck masses were more with 38(63.33%) compared to Females with neck masses with 22(36.67%). The most common presentation was of inflammatory origin with 36(60%) cases followed by benign lesions which were 10(16.67%) in number, followed by 7(11.67%) cases of congenital lesions and 6(10%) cases of malignant neck masses. The most common location was the submandibular location (30%) followed by the Carotid (26.67%) followed by midline (21.67%) and posterior triangle (15%). 35(58.33%) of the neck masses were unilateral and 12(20%) of the neck masses were bilateral. 24(40%) of neck masses were left sided and 34(56.67%) of the neck masses were right sided.On presentation, apart from neck swelling, 33.33% of masses had pain, 26.67% had fever, and 18.33% had discharge from the mass. On clinical examination, 30% of the masses elicited tenderness, 6.67% had wasting of muscles, and 16.67% were found to have restricted movement of the neck due to the mass. Neck masses are treated accordingly by conservative management for inflammatory lesions, incision, and drainage in case of abscess and surgical excision in case of congenital lesions and benign conditions. Malignant tumours are treated by chemoradiation. Conclusion: Detailed history taking, clinical examination, radiological investigation, haematological, microbiological, and histopathological examination aid in the confirmed diagnosis of neck masses. FNAC helped diagnose cases that were not resolved by conservative treatment. Excision or incision biopsy is preferred in cases where masses exceed 4-6 weeks duration and more than 2cm in size. USG neck is the first radiological investigation to be done followed by MRI and CT to appreciate bony erosion and adhesion to nearby neurovascular bundle.

DOI: 10.5281/zenodo.10962592

Introduction: Laparoscopic cholecystectomy, renowned for its minimally invasive approach, stands as the primary treatment for symptomatic gallstone disease globally. Despite its advantages over open cholecystectomy, concerns persist regarding perioperative complications. As evidence mounts on the short-term benefits of laparoscopic surgery, understanding its complications becomes paramount. Gallstone disease, a prevalent condition, burdens healthcare systems, making the refinement of laparoscopic techniques crucial. We aim to investigate the incidence and nature of perioperative complications in laparoscopic cholecystectomy. Material and Methods: This retrospective observational study enrolled 120 patients from M P Shah Medical Collage & GG Government hospital, Jamnagar conducted between June  2021 to May 2022. Approval was obtained from the Institutional Ethics Committee, with all patients providing informed consent. Inclusion criteria encompassed patients aged 18 years or older diagnosed with benign gallbladder disease. Patients underwent laparoscopic cholecystectomy performed by a single consultant surgeon, with thorough preoperative evaluation and meticulous recording of clinical details and complications. Descriptive analysis summarized the study population characteristics and complication incidences, with comparative analysis conducted using appropriate statistical methods. Results: In this study of 120 laparoscopic cholecystectomy patients, most were females (64.16%), with a mean age of 41.6±14.5 years. Comorbidities were present in 35.83% of cases. Common presenting symptoms included abdominal pain, dyspepsia, vomiting, and nausea. Postoperatively, patients stayed for an average of 2.13 days. The most common complication was trocar site bleeding (6.66%), with a 5.83% conversion rate to open cholecystectomy. Conclusion:  Our study emphasizes the need to address risk factors to reduce peri-operative complications in laparoscopic cholecystectomy. The observed conversion rate to open cholecystectomy underscores the importance of meticulous patient selection and surgical planning for better outcomes.

DOI: 10.5281/zenodo.10966657

Extended spectrum beta lactamase (ESBL) is quite fascinating. ESBL producing Enterobacteriaceae are a group of gram negative bacilli that developed resistance to a wide range of antibiotics, making them a significant public health concern. These can cause infection in various parts of human body, including Urinary tract, Blood stream and Respiratory tract system. Material and Method: This was a retrospective study carried out in the Department of Microbiology from August 2022 to October 2023. Various clinical samples like, Urine, Sputum, Pus, Wound swab, Blood, Tissue, Sterile body fluids, received in the laboratory from patients belonging to all age groups, both male and female were included in this study. Results: In this study overall2779 clinical samples was received during the study, out of which 779 (28%) Enterobacteriaceae group organisms were isolated in the microbiology department under sterile condition. Based on the total distribution of ESBL producing Enterobacteriaceae group organisms, the prevalence of ESBL producing organism were estimated to be (221, 42%) and Non ESBL producing organism were estimated to be (308,51%). Conclusion: A high degree of ESBL producers and carbapenem resistant Enterobacteriaceae are concerning; with emerging resistance to colistin, raising the fear of a return to the PR antibiotic era. An urgent intervention including creating awareness, establishment of robust infection control practices and implementing antibiotic stewardship program are the most important need of the hour.

DOI: 10.5281/zenodo.10966697

Background: Postpartum hemorrhage, or excessive bleeding at or after childbirth, is a potentially life-threatening complication of both vaginal delivery and cesarean section, and it is one of the leading causes of maternal morbidity and mortality worldwide. The primary cause of this hemorrhage is uterine atony. Oxytocin has proved to be very effective in reducing PPH incidence, thus making it a routinely used uterotonic agent. However, many women experience nausea, vomiting, chest pain, and discomfort attributed to the dose-dependent effects of oxytocin. Many alternatives, such as prostaglandin analogs, have been tested in the past; however, none have surpassed the efficacy of oxytocin. Carbetocin is a longer-acting oxytocin analog that works along the same molecular pathways and has a longer half-life of around 40 min. Carbetocin’s lack of relative gastrointestinal and cardiovascular side effects should make it a better alternative than oxytocin and other ergot alkaloids. Aim and Objectives: The aim of this study is to compare the hemodynamic effects of carbitocin with oxytocin and evaluate the efficacy of carbitocin versus oxytocin in preventing PPH. Material and Methods: This prospective randomized, double-blind study was conducted in a tertiary hospital associated with a medical college; 60 patients undergoing elective cesarean section under spinal anesthesia were randomly allocated to one of the two groups. Group I received 5 IU oxytocin in 10ml NS followed by 15 IU in 500ml NS infusion. Group II 100 mcg of Carbitocin in 10ml NS after delivery of right shoulder. Patients were assessed for SBP, DBP, heart rate, and SpO2 at 1,5,10 and 15 minutes, respectively. Total blood loss was evaluated at the end of surgery, and Hb was repeated after 24 hours to assess the effectiveness of the drugs in controlling PPH. Students’ t-tests and chi-square tests were used per the requirement, and a P value of <0.05 was considered statistically significant. Result: Out of 60 patients, 30 patients received oxytocin, and the remaining 30 received Carbitocin; Oxytocin group demonstrated significant tachycardia after 1 minute of drug administration compared to carbitocin Group, heart rate remained significantly higher in oxytocin group at 5,10 and 15 minutes compared to carbitocin Group, Both SBP & DBP remained significantly stable in Carbitocin group compared to oxytocin group at 1,5,10 & 15 minutes. The amount of blood loss and post-operative Haemoglobin Intraoperative SpO2 remained similar in both groups. Both groups were comparable in terms of side effect profile. The Carbitocin group was marginally better, showing a lesser incidence of Nausea, Vomiting & chest pain. Conclusion: Our study’s findings suggest that carbetocin is an equivalent drug to oxytocin in terms of uterotonic action and has a significantly better hemodynamic profile than oxytocin in patients undergoing LSCS under regional anesthesia.

DOI: 10.5281/zenodo.10966781

Introduction: Diabetic peripheral neuropathy denotes the manifestation of symptoms and indications of peripheral nerve impairment in individuals with diabetes, following the exclusion of other potential etiologies. Among the myriad long-term complications of diabetes, diabetic neuropathies stand as a prevalent occur-rence, affecting approximately 60% of diabetic patients. The objective of this investigation is to evaluate the effectiveness and safety profiles of tablet duloxetine 60 mg and tablet gabapentin 300 mg in patients presenting with diabetic polyneuropathy. Materials and Methods: This investigation comprised a randomized, comparative, double-blind parallel group study conducted on 78 patients experiencing diabetic polyneuropathic pain who were randomly assigned to two distinct groups. One group received duloxetine 60 mg while the other received gabapentin 300 mg. The evaluation of efficacy encompassed the utilization of the visual analog scale (VAS), the abbreviated version of the McGill pain questionnaire, and the patients’ global impression of change score. Safety assessment was conducted through the scrutiny of adverse drug reaction profiles. Results: Within the duloxetine group, the mean VAS score diminished significantly at the 3-month mark. Similarly, within the gabapentin group, the mean score diminished significantly at the 3-month mark. Noteworthy statistical significance was observed in the disparity between baseline and 3-month mean McGill scores in both groups. Conclusions: Duloxetine 60 mg once daily emerges as more effective than gabapentin 300 mg once daily in alleviating diabetic neuropathic pain. Furthermore, both pharmaceutical agents demonstrate favorable tolerability, albeit with gabapentin exhibiting superior tolerability compared to duloxetine.

DOI: 10.5281/zenodo.10966805

Context: There is a lacuna of studies on Attention Deficit Hyperactivity Disorder (ADHD) in the Indian context. Aims: (i) To identify the prevalence of ADHD in primary school children, (ii) To identify the gender difference in the prevalence of ADHD, (iii) To compare the distribution of ADHD among different socioeconomic status, (iv) To identify the presence of any co-morbid factors associated with ADHD. Settings and Design: This is a cross sectional study of school aged children selected from four different schools in Patna district. Materials and Methods: Seven hundred seventy children aged between 6 and 11 years were selected from four schools in Patna district after obtaining informed consent from their parents. The presence of ADHD was assessed by using Conner’s Abbreviated Rating Scale (CARS) given to parents and teachers. The children identified as having ADHD were assessed for the presence of any co-morbid factors by administering Children’s Behavioural Questionnaire (CBQ) to the teachers and Personal Information Questionnaire to the parents. Statistical Analysis: Statistical Product and Service Solutions (SPSS) 10 software Mean and Standard Deviation, and student’s t test were used for statistical analysis. Results: The prevalence of ADHD among primary school children was found to be 11.32%. Prevalence was found to be higher among the males (66.7%) as compared to that of females (33.3%). The prevalence among lower socio-economic group was found to be 16.33% and that among middle socio-economic group was 6.84%. The prevalence was highest in the age group 9 and 10 years. Conclusion: The present study shows a high prevalence of ADHD among primary school children with a higher prevalence among the males than the females.

DOI: 10.5281/zenodo.10968111

Gallbladder duplication is a rare congenital anomaly of the biliary tree. This study reported a rare case of duplication anomaly of gallbladder in a female aged 13 years, who presented with right hypochondrial pain for 6 months. Ultrasound findings suggested multiple stones in gallbladder and peroperatively she was found to have bilobed gallbladder. This case emphasized the need for complete removal of both gallbladders during laparoscopic cholecystectomy as the preoperative recognition decreases the risk of complications during laparoscopic cholecystectomy. The aim of this report was also to review the literature of previous cases to contrasted with the present one.

DOI: 10.5281/zenodo.10968175

Background and Objectives: Ocular trauma is a preventable public health problem throughout the world. These injuries occur in sports, home, assault, agriculture, and industrial and road traffic accident. Early diagnosis and prompt management ensures a better visual outcome improving the quality of life of affected individual; as the initial actions and interventions may be determinants for the final visual prognosis. To study the clinical profile of patients presenting with blunt ocular injuries in tertiary care centre and assessment of different types of management in various type of blunt trauma injuries. Material and Methods: This Prospective observational study was carried out in 100 patients from both rural and urban area suffering from blunt trauma patients attending the outpatient department and casualty under upgraded department of Ophthalmology, N.S.C.B. Medical College, and Jabalpur (M.P.) from 1st Jan 2020 to 31st August 2021. This was accomplished subsequent to receiving authorization from the Scientific Review Committee and Institutional Ethics Committee, as well as obtaining written consent from the patients. Results: In our study maximum number of cases 59 patients (59%) presented with the symptoms of diminution of vision with pain followed by 20 patients (20%) with the symptoms of diminution of vision, pain, watering, photophobia and foreign body sensation. At the time of presentation, steroids were given to 51 patients (51%), steroid and cycloplegics with pressure lowering agents given to 16 patients (16%) antibiotic eye drop and other anti-inflammatory eye drops with pressure lowering agents were given to 17 patients (17%), removal of foreign body with pad and bandage done to 15 patients (15%) and lid construction surgery with conservative treatment in a patients (1%). at the time of discharge oral steroids were prescribed to 51 patients (51%), steroids and cycloplegics with pressure lowering agents in 16 patients (16%), antibiotics eye drops with cycloplegics to 32 patients (32%) and oral antibiotics to a patients (1%). In our study it was found that after providing adequate treatment there was good visual recovery in 46 patients (46%), moderate visual recovery in 35 patients (35%) and poor visual recovery in 19 patients (19%). Conclusion: After considering the frequency, causes, nature, consequences and final visual outcome, any closed globe injury however trivial it may appear initially, must be deemed as an ophthalmic emergency and adequately dealt with proper care, caution to maintain normal structure and function of the eye. Better road traffic rules and education of public regarding protection of eye at work places helps in reducing the incidence of ocular trauma.

DOI: 10.5281/zenodo.10968190

Introduction: Stroke is the leading cause of death globally, with 1.8 million people affected annually. In India, it’s the leading cause of death. Neurology is learned through stroke, with 80% due to ischemic events and 20% posterior circulation strokes. Improved understanding of risk factors should focus on prevention rather than management. Aims and Objectives: The study aims to explore the causes and clinical manifestations of posterior circulation stroke, using imaging techniques like CT and MRI to assess the most frequently affected anatomical region. Material and methods: The study evaluated patients with PC stroke symptoms at King George Hospital, analyzing clinical history, risk factors, presentation mode, and hospital arrival time. Ethical committee approval was taken with IEC serial no: 62/IEC/AMC/OCT /2020 and the study period was from November 2019 to Octbber2020. The study used descriptive analysis, including mean, standard deviation, frequency, and proportion, with IBM SPSS version 22 for statistical analysis, without inferential or P values. Results: A study of 60 patients with posterior circulation stroke symptoms identified potential risk factors such as hypertension, diabetes, smoking, dyslipidemia, and coronary artery disease. Most patients initially displayed giddiness, vomiting, headaches, altered sensorium, and seizures. The study found distal territory involvement was more common, with ischemic  stroke being the most common. Conclusion: A study in a tertiary care hospital found that males are more affected by PC stroke, with hypertension being the most common risk factor. Large artery disease and cardio embolism are common causes.

DOI: 10.5281/zenodo.10968205

Background: Central and branch retinal vein occlusions (CRVO and BRVO) cause considerable ocular morbidity. Homocysteine levels, along with atherosclerosis, systemic hypertension, and age, have been discussed as risk factors. Homocysteine, a sulfur-containing nonprotein amino acid, may cause retinal vein blockage by damaging arteries and forming a thrombus. Methods: This retrospective case-control study examined the relationship between hyperhomocysteinemia, retinal vascular occlusion, and vitamin B₁₂ levels. There were 100 participants: 50 retinal vein occlusion patients and 50 age- and sex-matched controls. Statistical approaches were used to analyze blood homocysteine, lipid, vitamin B₁₂, and hypertension data. Results: Hyperhomocysteinemia (>15 umol/L) was linked to retinal vein occlusion (p < 0.05), suggesting a potential risk factor. Serum vitamin B₁₂ levels did not significantly predict retinal vein occlusion. Further research showed a substantial association between case group homocysteine and vitamin B₁₂ levels, suggesting a possible interaction. High blood pressure (>140 mmHg) was linked to retinal vein occlusion (p < 0.001), indicating hypertension as a substantial risk factor. Conclusion: Elevated homocysteine levels could be a controllable risk factor for retinal vein occlusive disorders, indicating the possible advantages of interventions like vitamin B₁₂ supplementation. More research is required to understand the intricate connections among homocysteine, vitamin B₁₂, and other contributing factors in the development of retinal vein occlusion. Recommendation: According to the findings, practitioners should monitor serum homocysteine levels in retinal vein occlusion patients and consider dietary changes and vitamin B₁₂ supplements. Hypertension management may also reduce retinal vein occlusion risk.

DOI: 10.5281/zenodo.10968214

Background: The World Health Organization defines “the term Low birth weight as birth weight less than 2500 grams irrespective of the duration of the gestational period.” Low-birth-weight (LBW) is “universal accepted indicator of health status. It is a subject of national concern and a focus of health policy. LBW has been shown to be associated with a higher risk of childhood mortality and morbidity. Methods: Total of 300 LBW babies (cases) and 600 NBW babies (controls) among all deliveries within the study duration of Two years. The sample size for the present study was 900, considering 1:2 ratio of cases: controls. Data collected were entered using Epidata 3.1 and coding was done. Conclusion: To conclude, present study showed higher rate of low birth weight found among mothers who were illiterates, and who had no primary and secondary education.

DOI: 10.5281/zenodo.10968224

Background: To assess the effects of Atorvastatin on C – reactive protein, Glycaemic Status, and Liver Enzymes in non-diabetic patients. Materials and Methods: The research involved 100 patients. Patients aged 28-72 years, who have not taken any drugs before, and are prescribed oral atorvastatin for dyslipidemia or for secondary prevention of cardiovascular or cerebrovascular illnesses were included in the research. All participants were receiving atorvastatin treatment and were monitored for one year, with a review of the mentioned parameters at the 1st, 6th, and 12th month marks. The study concluded after three follow-up visits. The main endpoint was the progression from normal blood sugar levels to prediabetes or diabetes, together with substantial alterations in CRP and hepatic enzyme levels. Results: The baseline mean values of FBS, PPBS, and CRP were compared with the values from the 1st follow-up visit (after one month), and the differences were determined to be statistically insignificant. After comparing the initial mean hepatic enzyme levels with those obtained four weeks later, the changes in ALT, AST, and ALP values were determined to be statistically insignificant. Significant changes (p-value=0.03) were seen in baseline serum triglyceride, blood cholesterol, LDL, and VLDL levels after four weeks. The average PPBS value was 111.33±5.38 mg/dL at the beginning and 113.41±3.99 mg/dL during the 6-month follow-up appointment. The difference in PPBS value was statistically significant at a significance level of p<0.05. There were no statistically significant changes in the mean FBS and CRP values at six months compared to the baseline. The FBS, PPBS, and CRP values were acquired after one year. The changes were determined to be statistically significant compared to the baseline values (p<0.05). ALT, AST, and ALP levels were collected after one year. They are then compared to their corresponding average baseline values. There was a statistically significant modest rise in mean ALT and AST readings (p<0.05), although the changes in ALP were not significant at the conclusion of the trial. Conclusion: HMG-CoA reductase inhibitors are widely used medications that have the ability to reduce negative cardiovascular outcomes. However, these cholesterol-lowering medications have been shown to negatively impact blood sugar management in individuals who had normal blood sugar levels at the start of treatment.

DOI: 10.5281/zenodo.10968243

Background: Using medications off-label is common in pediatric healthcare, especially in public hospitals, because there are few approved drugs for children. Various factors impact this practice, requiring careful consideration for the safety and effectiveness of pediatric treatment. Methods: An investigation was carried out in 15 urban public hospitals, including 102 pediatricians and 278 pediatric patient records. Semi-structured questionnaires and medical record reviews were utilized to collect information on prescribing patterns, beliefs, and influences on off-label drug utilization. Statistical analyses were conducted, including logistic regression, to determine significant predictors of off-label prescribing. Results: According to the research, 62% of pediatric patients received medications for conditions not approved by the FDA, with cardiovascular and neurological issues being the most frequent reasons. Various factors contribute to off-label prescribing, such as the availability of clinical evidence, the absence of approved alternatives, and recommendations from experts. Despite concerns about potential dangers, pediatricians have confidence in the safe delivery of treatment with appropriate supervision and dosage modifications. Parental approval and interaction were common but varied among doctors. Through the statistical analysis, connections were found between the probability of off-label prescribing and factors such as physician experience, hospital location, and availability of pediatric pharmacology consultants. Conclusion: Off-label medication use is widespread in pediatric care, driven by clinical necessity and supported by available evidence and expert opinions. However, concerns regarding safety and the need for comprehensive guidelines persist. Continuous education and access to specialized support are recommended to optimize off-label prescribing practices and ensure pediatric patient safety. Recommendation: Healthcare institutions should prioritize the development of comprehensive guidelines and provide continuous education and support for pediatricians to make informed off-label prescribing decisions. Collaboration with pediatric pharmacology consultants can further enhance prescribing practices and ensure patient safety.

DOI: 10.5281/zenodo.10968326

Background: The explosion of video-assisted surgery in past 20 years was a result of the development of compact, high resolution, charged coupled devices that could be mounted on the internal end of flexible endoscopes or on the external end of the Hopkins telescope. Coupled with bright light sources, fibre optic cables, and high-resolution video monitors, the video endoscope has changed our understanding of surgical anatomy and reshaped surgical practice. Aims and Objectives: (1) To evaluate how much overlap of mesh is optimal for the hernia repair. (2) To analyze and evaluate the minimum number of the transfascial stitches for optimal fixation of the mesh with the abdominal wall. (3) To analyze and evaluate the minimum numbers of the tacks for optimal fixation of the mesh with abdominal wall. (4) To analyze and evaluate post-op recovery time, complications and recurrence. Methods: A Prospective study was carried out on patients presenting with complaints suggestive of ventral (incisional) hernia in the Emergency or Outpatients Department of Surgery Rajkiya Medical College (R.M.C.) Jalaun. The study time was between September 2022 to February 2024. Observation: In our study Length of post-op hospital stay is reduced to 2. 75 days, operative time is reduced to average 48.5 minutes Vs 60 to 90 minutes in previous studies, In our study, the fixation of mesh is done with absorbable suture (vicryl2-0), prolene 2-0 and tackers, Incidence of enterotomy is 0.5%, seroma formation is reported in 4% of the patients, which is managed conservatively. Conclusion: (1) Requires advance expertise of operating surgeon. (2) Prolene mesh can be placed intra peritoneally, we have not found any post-op complication in total duration of our study. (3) While placing the mesh in preperitoneum only fixation at the four corners of the mesh is required. (4) Mesh fixation can also be done with the absorbable suture even when it is placed IPOM.

DOI: 10.5281/zenodo.10968427

Background: Diagnosis of acute appendicitis (AA) is often confusing, leading to delay in diagnosis and negative appendectomies. To solve the problem, several scoring systems, commonly Modified Alvarado Scoring System (MASS) and RIPASA score (Raja Isteri Pengiran Anak Saleha Appendicitis score) had already been studied. Diagnostic accuracy(DA) of the former is lower than the later. Although, AA is a disease of mostly young with slight male dominance, it can affect all age groups. The negative appendectomy rate (NAR) is challenging particularly in young females. We intend to study gender-specific and age-group specific comparison of the above two scoring systems in our rural Indian patients, for which available literatures are quite scanty till date. Methods: The present study was conducted in the department of General Surgery, Midnapore Medical College, Paschim Medinipur, West Bengal, India. We prospectively studied 160 patients with right iliac fossa pain; categorized into three agegroups, namely Group I- less than 15 years, Group II- 15 to 60 years and Group III- more than 60 years. Two Scoring methods were applied to all patients. Acute appendicitis was confirmed by histopathology. Results: Our study revealed much lower NAR using RIPASA score particularly in females of all age groups (10.41% versus 14.6% in males). The DA of MASS and RIPASA were 72.22 versus 91.66% in Group I, 57.14 versus 74.60% in Group II and 64 versus 72% in Group III respectively. Conclusions: RIPASA score is more convenient and accurate than MASS, not only in females but also in all age groups, especially in young patients in rural Indian population.

DOI: 10.5281/zenodo.10968560

Background: Phyllodes tumors are uncommon breast neoplasms with diverse biological behavior and clinical presentations, leading to a potential for recurrence. However, the specific clinicopathological risk factors associated with local recurrence remain unclear. To address this gap, this study aimed to analyze the relationship between clinicopathological features and recurrence status in patients with breast phyllodes tumors. Materials and Methods: This single Hospital-based, retrospective study was conducted on 113 histopathologically proven women with phyllodes tumors who were referred to our center, from January 2016 to December 2018. Clinical and pathological features, local and regional recurrence, distant metastasis, and overall survival were determined. SPSS 15.0 statistical software was used for analysis. Results: The mean age of patients with phyllodes tumors (PTs) at diagnosis was 41.5 years (range: 24-69 years). Of these, 71 (68.1%) were 40 years old or younger, while 42 (34.5%) were older than 40. Tumor histology was benign in 24 (21.2%) patients, borderline in 27 (23.9%), and malignant in 62 (54.9%). We found a significant correlation between tumor size and tumor grade. The overall five-year recurrence-free survival rate was 65%. However, the five-year recurrence-free survival rates for benign, borderline, and malignant phyllodes tumors were 76%, 64%, and 60%, respectively. We found that both type of surgery and tumor size exceeding 10 cm significantly contributed to recurrence. Notably, patients who underwent lumpectomies had a higher recurrence rate than those who underwent mastectomies. Conclusion: Wide local excision seems to be the initial procedure of choice for all PTs, and mastectomy for recurrent tumours. Further studies are needed to define the role of adjuvant therapies.

DOI: 10.5281/zenodo.10968582

Background: Objective was to study the histopathological spectrum of coronary heart diseases in autopsy specimens, that play a major role accounting 80% as cause of death with varying in respect to most common age group affected, single, and double or triple coronary blood vessel involvement. Also includes cardiomyopathy, myocarditis and infective pathology leading to death. Methods: This study carried out from January2022 to November 2023. Total 3199 medicolegal autopsies were received during this period. Out of 3199, specimens of heart were 3166. 45 specimens were Autolysed and 100 were pediatric hearts that were excluded from our study. So, 3021 specimens of heart were included in the study. Gross and microscopic findings on H and E-stained sections were studied. Results: Out of 3021 cases, 1987 cases showed atherosclerosis, acute coronary event noted in 12 cases, 394 cases showed features of myocardial infarction, myocardial hypertrophy was found in 114 cases, 10 cases revealed myocarditis, Cardiomyopathy in 6 cases, Myocardial bridging in 3 cases, pericarditis in 4 cases and one case of aortic stenosis. Double vessel atherosclerosis was noted in 196(40.32%). LAD most common followed by RCA in CAD. Out of 501 cases, 167 had no identifiable cause of death even after complete gross and microscopic autopsy was performed. Conclusions: Most common cause of death is Coronary artery atherosclerosis which accounting to 65.77%. Leading to myocardial ischaemia in age group 21-60 years is probably the commonest finding in death cases subjected to medicolegal autopsies.

DOI: 10.5281/zenodo.10968645

Background: Traumatic Brain Injury (TBI) is a global epidemic causing significant morbidity and mortality. The outcome of TBI depends on quality of care. This study was ensued to evaluate the characteristics of TBIs in North Bihar and the outcomes. Materials and Methods: This prospective study included details of TBI patients seen in the Surgery Department of Darbhanga Medical College and Hospital, Darbhanga, Bihar. All patients of any age with TBI were included in the study. Then inclusion and exclusion criteria were applied and the Study Population was obtained. The patients were clinically assessed and imaging was done and the data obtained were compared to find any correlation. The outcomes were also assessed. Results: During the study period, 2,354 patients of TBI were seen. Out of this, after applying inclusion and exclusion criteria, 2,041 patients were included in Study Population. There were 70.4% males and 29.6% females. Most common culprit was Road Traffic Accidents (RTA) (56%), followed by Assaults (33%). Head injury was mostly mild (64%) and 16% had severe injury. Severe Head Injury patients had more incidence of intracranial bleed compared to Mild Head Injury. Thus Correlation exists between Clinical features and radiological findings. Mild head injury has best prognosis with complete recovery compared to severe head injury having 20% mortality. Prognosis also depends on the distance from where the patient is coming. Conclusions: Traumatic Brain Injuries are mostly mild to moderate with low mortality rate.

DOI: 10.5281/zenodo.10968663

Background: Polycystic ovarian syndrome (PCOS) is a hormonal disorder that often affects women of reproductive age. Women with PCOS may experience depression and anxiety due to hormonal imbalances, concerns about their physical appearance, and societal pressures related to infertility. This study investigates the prevalence of depression and anxiety symptoms in PCOS patients and their relationship with various socioeconomic factors. Methods: The research conducted at Atal Bihari Government Medical College and Hospital in Vidisha, MP, over a period of six months from November 2022 to April 2023, focused on examining the socio-demographic and medical characteristics of seventy subjects diagnosed with PCOS. Participants, aged between 18 and 35 years, were selected based on Rotterdam’s criteria. A semi-structured questionnaire was utilized to collect data on socio-demographic factors, PCOS details, menstrual patterns, anthropometric measurements, medical and treatment history, and relevant scales. Exclusion criteria included incomplete PCOS diagnosis, ongoing psychiatric treatment, pregnancy, menopause, and hirsutism due to associated disorders. Result:  In our study of 70 PCOS patients, findings revealed that 38.57% exhibited borderline clinical depression, 12.87% moderate depression, and 4.285% severe depression based on BDI scores. Additionally, 50% had mild depression, 20% moderate, and 2.85% severe according to HAM-D. Anxiety levels were also notable, with 47.14% experiencing mild anxiety, 17.14% moderate, 10% severe, and 25.71% extreme anxiety on the Hamilton Anxiety Rating Scale. Body image disturbances affected 31.42% of patients, while 21.42% had low self-esteem, 75.71% scored moderately, and only 2.85% exhibited high self-esteem. Conclusion:  This study highlights a greater prevalence of depression and anxiety compared to body image concerns and low self-esteem among individuals with PCOS. Early identification of these mental health issues and appropriate referrals to psychiatrists may aid patients in better managing their condition and ultimately lead to better outcomes.

DOI: 10.5281/zenodo.10968678

Background: Caesarean deliveries are associated with increased maternal and neonatal morbidity and mortality when compared to spontaneous vaginal deliveries. Therefore, this study was conducted to analyse the factors influencing mode of delivery in primigravida to reduce caesarean section rates. Methods: This is a retrospective observational study done at PMCH & RI for a period of 12 months. The data was collected through predesigned proforma by reviewing medical records and analysed using SPPS software. Results: Out of 1101 deliveries during the study period 608 were primigravida in which 8 were excluded for multiple pregnancy. Out of 600 deliveries, 371 (61.83%) had vaginal delivery and 229 ( 38.16% ) underwent caesarean section. Maternal age of 20-25 years, spontaneous onset / progress of labour, Fetal weight 2.5-3 kgs, clear liquor were the significant facilitating factors for normal vaginal delivery. Conclusion: The prediction of mode of delivery depends on both obstetrics and fetal parameters. Proper counselling and pain management may encourage patient to choose vaginal delivery can significantly reduce caesarean section rates.

DOI: 10.5281/zenodo.10968684

Introduction: Plantar fasciitis is a prevalent condition causing heel pain in adults, particularly affecting individuals in the age group of 40-60 years, and stands as a significant contributor to occupational impairment. Treatment options can be broadly categorized into non-invasive and invasive modalities. Invasive modalities, such as local injections and surgical interventions, are recommended for individuals who do not respond to non-invasive conservative treatments. Local Steroid Injection (LSI) is the prevalent invasive treatment method, while Dry Needling (DN) has emerged as a novel treatment modality more recently. Aim: The aim of this systematic review is to critically analyze the literature to find the effect of dry needling when compared with corticosteroid injection in treating Plantar Fascitis. Method: This systematic review was directed according to “Preferred Reporting Items for Systematic Reviews and Meta-analysis” Guidelines: The principal research question that was studied “Is dry needling better than corticosteroid injections in treating plantar fascitis?” Various different electronic databases were used to search relevant articles using different keywords. Articles were collected altogether and selected on the basis of eligibility criteria. The closing sets of articles were selected after complete screening. Result: Both dry needling and corticosteroid injections are effective in treating tendinopathy for both short term whereas dry needling is more significantly effective in long-term use. Conclusion: Dry needling is superior to corticosteroid injection in treating plantar fascitis.

DOI: 10.5281/zenodo.10968697

Vericiguat is approved for the treatment of adults with symptomatic, chronic heart failure with reduced ejection fraction (HFrEF) and is the first oral soluble guanylate cyclase (sGC) stimulator. Due to oxidative stress and endothelial dysfunction, the activity of sGC and NO bioavailability were decreased, which resulted in myocardial and vascular dysfunction. Vericiguat function, through increasing NO availability and reducing the oxidized forms of sGC, results in smooth muscle relaxation and vasodilatation. The objective of the Phase-II SOCRATES-REDUCED study was to determine the optimal dose and tolerability in patients with worsening chronic heart failure and reduced left ventricular ejection fraction (LVEF), whereas the Phase III VICTORIA trial was associated with significantly reducing the cardiovascular death and first hospitalization from heart failure. Vericiguat therapy can successfully lower the risk of mortality rate and first hospitalization from heart failure but the only adverse events were symptomatic hypotension and syncope. Thus, vericiguat was proved to be an effective treatment well tolerated with opinion in patients with symptomatic chronic heart failure with a recent worsening effect. This review consists of introduction, mechanism of action of vericiguat, dose and pharmacokinetics, efficacy, safety, precautions, regulatory status and future perspective and conclusion.

DOI: 10.5281/zenodo.10968703

Background: Women’s health has always taken a backseat and it is no different when it comes to the surgical specialties. Moreover, hospitals catering to the lower economic strata of society, such as government hospitals, present a rather unique set of problems. Although the lack of economic resources contributes significantly, several other factors such as lack of awareness and cultural misconceptions come into play. Furthermore with women still being considered the ‘second gender’ in Indian societies, the implications of the above factors is far more evident. Surgical care is thus sought only in life-threatening situations, thereby affecting surgical outcomes. In a country like India with varied practices and mindsets, the proportion of these contributing elements may also vary with region. Therefore, different geographical regions and communities need to be individually studied to formulate distinctive community-based solutions to ensure timely access to care. Hence via this study we attempted to understand the health seeking behaviour of our women population. Methods: We conducted a survey in the in-patient general surgery ward of a tertiary care hospital namely Krishnarajendra Hospital, Mysore. Krishnarajendra hospital is the government run tertiary care multispecialty hospital in the district of Mysore. Results: Lack of awareness was the most common cause of delay with 70% of the studied population reflecting the same, followed by economic factors (17%). Conclusion: Sociodemographic factors play a massive role in the health seeking behaviour of women wherein lack of awareness is the most common cause of delay in accessing surgical care. This delay affects health outcomes. Further studies to gauge the various barriers in accessing surgical care amongst women ought to be performed on a larger scale to determine specific points of intervention.

DOI: 10.5281/zenodo.10968726

Purpose: To quantitavely evaluate the vascular density in perifoveal and foveal region as well as Subfoveal choroidal thickness (SFCT) of Idiopathic Macular Telangiectasia type-2 (MacTel 2) patients through Swept Source Optical Coherence Tomography (SS-OCT) and Optical Coherence angiography (SS-OCTA). Materials and Methods: It was a prospective observational study in which MacTel 2 patients were compared with age matched normal controls. Group 1 included a total of 26 eyes of 13 MacTel Type 2 patients. Group 2 included 26 eyes of 13 ages and sex matched normal controls. All patients underwent a comprehensive ophthalmologic examination. All patients and controls underwent a Swept Source Optical Coherence Angiography (SS-OCTA). Data collected included vascular density (VD) in foveal and perifoveal quadrants, Subfoveal Choroidal thickness (SFCT) as well as morphological features on OCT. Results: Mean Best corrected Visual acuity (BCVA) in logMAR of Mactel 2 patients and control group were 0.57±0.37 and 0.15±0.15 (p =<0.001). The most common findings on OCT Angiography images were decrease in vascular density in superficial vascular plexus. The retinal foveal vascular density was significantly lower in patients in MacTel-2 than the control group (20.68±6.73 vs 24.89±3.87, p=0.008). Besides vascular density was also lower in all four perifoveal quadrants. The mean SFCT was 307.46 microns and 275.15 μm in patients with MacTel-2 and control group respectively. Though SFCT was lower in Mactel patients, the difference was not statistically significant (p=0.177). Conclusions: Reduced Vascular density in foveal and parafoveal areas is an important OCTA imaging biomarker in patients with Mactel Type 2. Subfoveal Choroidal thickness does not appear to be significantly reduced in Mactel type 2 eyes compared to the control group.

DOI: 10.5281/zenodo.10968744

Background: Primary gastrointestinal tract lymphoma (PGIL) represents a rare malignancy of GIT accounting for 1-4% of total malignancies. While the gastrointestinal tract is more commonly involved secondarily from nodal lymphoma, primary cases can originate from any part of gastrointestinal tract extending from oropharynx to anal canal. Histopathological examination of biopsy samples taken during endoscopy is the gold standard for diagnosis. PGIL represents a heterogeneous group of malignant neoplasm which differs in terms of etiological factors, pathogenesis, immunohistochemical profile, treatment strategies and prognosis. The present study aimed to evaluate histological subtypes of primary gastrointestinal lymphoma on the basis of morphology, immunohistochemistry and its anatomic distribution. Materials and Methods: A total of 10 cases of GI lymphomas received during study period of one year were archived and evaluated retrospectively. Proper IHC panel was put for all the cases for categorization of the tumor. Observations & Results: In this case series, most of the patients were male with only 2 females diagnosed with lymphoma. Patient’s age ranged from 3 years to 74 years with caecum being the most commonly affected site with involvement in 4 patients followed by stomach in 3 patients. Histologically, DLBCL was the most common type of lymphoma in this study and was diagnosed in 6 patients; all of these cases were of the germinal center B cell (GCB) subtype. Single case of Burkitt’s lymphoma was diagnosed in a three-year-old child. Conclusion: In recent years, the incidence of lymphoma is rising in young adults, so it is important to diagnose these lesions early. Most of the gastrointestinal lymphomas are indolent and slow growing and have good prognosis if detected early.

DOI: 10.5281/zenodo.10968758

Drowning remains a global public health problem, claiming many lives each year, especially among young children and youth. This summary presents a comprehensive demographic study of drowning incidents, analysing the complex interplay of various factors that contribute to this global public health problem. By examining the demographics of drowning victims, this study aims to identify vulnerable populations and inform targeted prevention strategies to reduce drowning deaths. This study uses extensive data from different geographic regions and reveals important patterns of drowning. It shows that young children and young people make up a disproportionate number of victims, as men are more prone to drowning than women. Additionally, socioeconomic inequality is a determining factor, with poor communities experiencing higher drowning rates due to limited water safety resources and education.  The study examines the contextual factors that influence drowning incidents and highlights the prevalence of drowning in natural bodies of water, including rivers, lakes and oceans, compared to man-made environments such as swimming pools. It also examines the role of alcohol consumption, inadequate supervision and lack of swimming skills as important risk factors for drowning deaths. In addition, the study assesses the effectiveness of existing drone prevention initiatives and identifies gaps in their coverage. Analysing successful interventions such as water safety education programs and lifesaving equipment distribution, the study recommends evidence-based strategies to reduce the risk of drowning in vulnerable populations. In conclusion, this demographic study on drowning highlights the urgent need for targeted interventions tailored to specific vulnerable populations. By understanding the factors that influence drowning incidents, policy makers, public health agencies and conservation organizations can proactively plan and implement preventive measures and ultimately work to curb the number of drowning tragedies worldwide.

DOI: 10.5281/zenodo.10968764

Introduction: Non-communicable diseases (NCDs) are one of the major health and development challenges of the 21st century, in terms of both the human suffering they cause and the harm they inflict on the socioeconomic fabric of countries, particularly low- and middle-income countries. No government can afford to ignore the rising burden of NCDs. In the absence of evidence-based actions, the human, social and economic costs of NCDs will continue to grow and overwhelm the capacity of countries to address them. Aims and Objectives: (1) To assess the prevalence of diabetes mellitus in the Resettlement Colonies of urban field practice area of School of Medical Sciences &Research (SMS&R), Gautam Buddh Nagar. (2) To study the prevalence of risk factors of diabetes mellitus in the study population and their association with Diabetes Mellitus. Material and Method: The study design was Community Based Cross sectional study from January 2017 – January 2018. The study was conducted among urban field practice area of SMS&R. Statistical analysis used: Data analysis was carried out utilizing IBM SPSS (Statistical Package for Social Sciences developed by International Business Machines). 20.0 version and MS Excel sheet. Results: Overall prevalence of Diabetes was found to be 21.7%. In present study significantly higher prevalence of Diabetes (23.8%) was found in those consuming Fruit and vegetables in Diet, similar pattern seen in IFG glucose also (57.3%) The prevalence of diabetes (30.8%) and impaired fasting glucose (69.2%) was higher in those who had family history of diabetes and this association was statistically not significant. Prevalence of Diabetes males (22.8%) was slightly higher than females (20.5%). The prevalence of Diabetes showed significant association with family income. Prevalence of Diabetes was found significantly higher among unemployed / unskilled subjects (26.4% and 24.7% respectively) as compared to professionals (15.1%). Conclusions: Overall prevalence of Diabetes was found to be high.

DOI: 10.5281/zenodo.10968867

Background: Burn wound infection is a major public health problem and globally the most devastating form of trauma. It delays healing, causes scarring and may result in bacteraemia, sepsis or multiple-organ dysfunction syndrome leading to increased morbidity and mortality. Materials and Methods: The present study was a hospital based prospective observational study on 120 burn patients admitted to the Burn ICU. The wound swabs collected from the included patients were Gram stained & bacterial and fungal culture and sensitivity was done. Results: Out of the total 120 patients, highest 41(34.16%) belonged to the 21-30 years age bracket. Preponderance of males 62(51.66%) was more than females 58(48.33%). Flame burn was found to be the commonest form of burn injury (66.7%). Bacterial culture was positive in 104 (87%) of cases, while in 12(10%) cases fungus was isolated. 154 bacterial isolates were isolated, 131 (85%) were Gram negative while rest 23(15%) were Gram positive. Pseudomonas aeruginosa was the most common bacteria isolated from 60 (39%) samples followed by Klebsiella species 28(18%) samples. Pseudomonas aeruginosa (n=60) was mostly susceptible to Imipenem (75%) followed by Gentamicin and Tigecycline with 70% and 50% respectively. Gram positive bacterial isolates (n=23) were found to be most susceptible to Vancomycin 23(100%) and Linezolid 18(100%). Conclusion: The findings of the present study revealed that Gram negative bacilli are still predominant pathogens infecting the burn wounds in this region. Effective strict isolation techniques and infection control are thus needed to decrease the occurrence of burn wound infection.

DOI: 10.5281/zenodo.10968877

Introduction: Nephrotic syndrome includes the clinical manifestation of glomerular diseases associated with heavy proteinuria i.e., nephrotic range (40 mg/m²/hr or >1000 mg/m²/day; spot Up/Uc>2 mg/mg; 3-4+ by urine dipstick); hypoalbuminemia (albumin <3.0 g/dL); and edema. In children, the most common cause of nephrotic syndrome is idiopathic or primary nephrotic syndrome (INS), also called nephrosis. In the kidney, the predominant source of IL-18 is the tubular epithelial cells. In the recent years, the biological and pathological roles of IL-18 have been studied in many diseases. In clinical practice, IL-18 is expected to be useful in the diagnosis of diseases and the estimation of disease severity and prognosis. Methods: This case control study was conducted in 60 children with nephrotic syndrome, 30 children each in steroid sensitive group and steroid resistant group, compared with 30 controls who were admitted for illnesses other than nephrotic syndrome. Interleukin 18, a urinary biomarker for predicting steroid resistance was compared between the steroid sensitive and steroid resistant group and controls. Results: Urine interleukin 18 levels were found to be significantly higher in the steroid resistant group than the steroid sensitive group which in turn is higher than the control group. A positive correlation was established between the urinary IL 18 levels and the degree of proteinuria both in the steroid sensitive and steroid resistant groups. Other parameters such as serum creatinine, serum cholesterol, urine spot PCR were found to be higher in children with steroid resistant nephrotic syndrome. Conclusion: This study evaluated the prediction of steroid resistance in children with nephrotic syndrome using urinary interleukin 18 which is one of the biomarkers studied in proteome profiling of urine. Children with steroid resistant nephrotic syndrome showed higher levels of urinary IL 18 which will enable us to predict subsequent clinical course and early initiation of steroid sparing drugs as well as to search for molecular pathways and targets associated with steroid resistance. Other biochemical parameters like serum cholesterol, serum creatinine, urine spot PCR and 24 hour urine protein were also found to be significantly higher in the steroid resistant group, thus enabling us in predicting steroid resistance.

DOI: 10.5281/zenodo.10968918

Introduction: Accurate tissue approximation is essential for operative repair of defects and execution of defects and execution of safe healing process. The perfectness of tissue approximation and type of approximation influences the tissue healing rate, post-operative early and late complication of surgical wound and economic burden of the hospital. In this modern era broadly speaking the materials or gadgets for approximation of tissues are the sutures, staples or clips, glues, steritapes etc. the aim of this study is to compare the outcome of wound closure in terms of effectiveness, complications, patient satisfaction and cost efficiency. Methods: This is a comparison study of prospective type conducted for a period of 6 months in a tertiary care hospital with 80 subjects. The included patients were distributed into two groups randomly of 40 subjects each and one group was applied sutures and other group applied skin staplers for skin closure. Data like wound length, duration of closure, complications, outcome of scar and patient satisfaction score noted. Results: The study involved 80 participants, who underwent both emergency and elective surgical procedures. The mean time taken for skin closure using skin sutures is 8.42 minutes and mean time for skin closure using skin staplers is 2.03 minutes. Incidence of complications using skin sutures is 30% and reduced to 12.5% using skin staplers. The patient satisfaction was equivocal. Conclusion: Staplers as compared to sutures are efficient method of surgical skin closure in terms of effectiveness, relatively less complication rate, and time conservation. Compliance for surgeons is also good for skin staplers, they are cost effective in terms of reducing complication rates and hospital cost burden.

DOI: 10.5281/zenodo.10968926

Introduction: Neonatal septicemia is the leading cause of neonatal mortality and morbidity in India. In India, the primary cause of infant mortality and morbidity is neonatal septicemia. The goal of the current investigation was to identify the common pathogens isolated from the blood of septicemic newborns in the Neonatal Intensive Care Unit (NICU) and their bacteriological profile and pattern of antibiotic sensitivity. AIM & Objective: Isolation and identification of pathogens responsible for neonatal septicemia from the blood with their antibiotic susceptibility pattern. Materials and Methods: For a period of one year, from August 2021 to July 2022, blood samples from cases of clinically suspected neonatal septicemia were subjected to aerobic culture, and the isolates obtained were evaluated for antibiotic susceptibility pattern in accordance with CLSI standards. Results: Four hundred blood samples were examined; of these, 168 (42%) had a positive blood culture. Of these, 50 (29%) were female, 118 (58.4%) were male, and 92 (54.7%) were preterm. Gram negative organisms have been isolated from 66 cases (392 %) and Gram positive organisms from 64 cases (38.09%). The majority of the organisms in this study were gram negative. Of the gram-positive bacteria, 28 (45%) were staphylococcus epidermidis and 10 (0.16%) were staphylococcus aureus. Out of the total number of isolates, 24 (38.7%) were candida, of which 21 (0.33%) were candida auris, 3 were candida albicans, and only 2 (0.03%) were streptococci. One instance of Acinitobacter (0.01%), 25 (37.8%) Klebsiella species, and 29 (43.9%) Gram-negative E. Coli species were all isolated. Antibiotic susceptibility pattern: Two enterococci (20%) and five gram-negative isolates (0.17%) both exhibited vancomycin resistance. Methicillin resistance was observed in just 2 (0.05%) of the gram-positive Staphylococcus aureus isolates. Conclusion: This study emphasizes how multi-drug-resistant bacteria have emerged in our setup and how Gram-negative organisms are mostly responsible for newborn sepsis. Considering the changing spectrum of organisms that cause newborn septicemia and their patterns of antibiotic susceptibility, it is important to periodically examine cases in order to identify any evolving trends in the infecting organisms and their antimicrobial susceptibility.

DOI: 10.5281/zenodo.10968937

Middle ear hemorrhage and drowning are two topics that are often associated with violent asphyxial deaths. Un-derstanding the relationship between these two can provide valuable insights into forensic investigations and medical examinations. When an individual drowns, the process involves the inhalation of water or other fluids, leading to a lack of oxygen supply and subsequent asphyxiation. During this traumatic event, the body under-goes significant physiological changes, including increased pressure on various organs and tissues. One specific consequence of drowning is middle ear hemorrhage. The middle ear is a delicate structure located behind the eardrum, responsible for transmitting sound signals to the brain. When subjected to intense pressure changes during drowning, such as rapid submersion or resurfacing, blood vessels in the middle ear can rupture, resulting in hemorrhage. Middle ear hemorrhage serves as an important indicator in forensic autopsies when investigating cases of violent asphyxial death due to drowning. It can help determine whether drowning was indeed the cause of death or if other factors played a role. Furthermore, studying middle ear hemorrhage in relation to drowning can aid in distinguishing between fresh and postmortem injuries. This differentiation is crucial for accurate eval-uating the exact cause and manner of a fatality after forensic examinations. In conclusion, understanding the connection between middle ear hemorrhage and drowning provides valuable insights into violent asphyxial deaths. By examining this specific injury pattern during autopsies and forensic investigations, experts can un-ravel critical information that aids in determining cause of death accurately.

DOI: 10.5281/zenodo.10968944

Introduction: Ovarian cancer is the most common cause of surgery and hospitalization. It may occur at any age and is the site of most non-neoplastic and neoplastic lesions. Aims and Objectives: The objective of this research was to identify the histological findings of ovarian lesions. Materials and Methods: From January 2023 to January 2024, 202 cases of ovarian lesions were examined in this study which was conducted at the pathology department at the Pacific Institute of Medical Sciences in Udaipur. The specimens were received by the histopathology department in a container filled with formalin, and they underwent standard grossing and H and E staining procedures. Results: Neoplastic ovarian lesions occurred 24.75% of the time. The majority of ovarian cancers (68%) were found to be surface epithelial tumors, with germ cell tumors (26%) coming in second. High-grade serous carcinoma (10%) was the malignant tumor type, and serous cystadenoma (40%) was the most common benign tumor type according to histopathology. Non neoplastic lesions accounts for 75.25 where simple cysts accounted for the majority of non-neoplastic ovarian lesions (29%), with follicular cysts coming in second (25.65%). Conclusion: The incidence rate increasing with age, with the fourth and fifth decades showing the highest number of new cases detected. The oldest patient in our study was over 60 years old, and the youngest was only 5 years old.

DOI: 10.5281/zenodo.10968950

Introduction: Intertrochanteric fracture is one of the most common fracture in elderly population. In a randomized prospective study to compare the functional and radiological outcome of Proximal Femoral Nail anti-rotation-Asia(PFNA-II) and Dynamic Hip screw (DHS) used in fixation of stable (AO type 31 A1-A2.1) intertrochanteric fractures. Methods: 30 patients with stable intertrochanteric fractures treated with DHS and PFNA-II in last 1 year were enrolled in the study. Intraoperative variables-surgical time, blood loss, fluoroscopy time and post-operative variables-union rate, change in neck shaft angle, functional outcome in terms of Modified Harris Hip Score(HHS) &  Radiological findings  were studied and compared between both the groups. Results: The average age of the patients was 60 years .Out of 30 patients 18 males and 12 females patients were there In our series we found that patients with DHS had increased intraoperative blood loss, longer duration of surgery, and required longer time for mobilization while patients who underwent PFNAII had lower intraoperative blood loss, shorter duration of surgery, and allowed early mobilization. The patients treated with PFNAII started early ambulation as they had better Harris Hip Score in the early post-op period. At the end of 12th month, there was not much difference in the functional outcome between the two groups. Conclusions: PFNAII is better than DHS in stable intertrochanteric fractures in terms of decreased blood loss, reduced duration of surgery, early weight bearing and mobilization, reduced hospital stay, decreased risk of infection and decreased complications.

DOI: 10.5281/zenodo.10968958

Introduction: Cardiovascular abnormalities, including left ventricular hypertrophy (LVH), dilatation, and impaired systolic and diastolic functioning of the left ventricle, are the main factors leading to illness and mortality in people with chronic kidney disease (CKD). Cardiovascular issues are the leading cause of mortality in individuals with chronic kidney disease, accounting for around 50% of deaths. The objective of this study was to identify changes in electrocardiograms and echocardiograms in persons with chronic renal disease. Materials and Methods: A source of 60 adults, aged 21 years and above, who had clinical symptoms characteristic of chronic renal illness, were included. Each participant underwent electroencephalogram (ECG) and echocardiography to assess cardiac structural and functional parameters. Results: The majority of participants were between the ages of 51 and 60 (35%), with a higher number of males. 35% of patients had left ventricular hypertrophy on ECG results, whereas 30% showed ischemia, 8.33% had conduction abnormalities, 6.67% had left atrial dysfunction, 3.33% had arrhythmia, and 1.66% had ventricular fibrillation. Echocardiography identified left ventricular hypertrophy in 38.33% of cases, pericardial effusion in 11.67%, diastolic dysfunction in 10%, calcified valves in 6.67%, regurgitation in 6.67%, systolic dysfunction in 3.33%, and ischemia in 3.33%. Conclusion: Electrocardiography (ECG) and echocardiography (Echo) are crucial in assessing the cardiac structural and functional aspect, as well as determining the level of risk for future prognosis. Regular echocardiographic screening is strongly advised for the detection and treatment of cardiac abnormalities in individuals with chronic kidney disease.

DOI: 10.5281/zenodo.10968968

Background: Hernias, defined as the abnormal protrusion of organs through an opening, often contained within a sac, has been a significant medical concern. With the prevalence rates of hernias reported between 2% and 11%, the choice of optimal hernia repair technique remains debated among surgeons. This study compares the outcomes of on-lay and sub-lay mesh repairs in open ventral hernia surgeries, focusing on their effectiveness and long-term results. Methods: Conducted at the Department of Surgery at JLNMCH, Bhagalpur, this prospective study over two years included patients with postoperative ventral hernias. Participants were randomly assigned to undergo hernia repair using either the sub-lay or on-lay mesh technique. The study aimed to assess primary outcomes such as surgery length, suction drain time, wound complications, and secondary outcomes including chronic pain and hernia recurrence. Results: The study analyzed data from 115 patients, finding no significant difference in the duration of operation between the sub-lay and on-lay groups. However, the duration of the suction drain was significantly shorter, and wound complications were notably fewer in the sub-lay group. Chronic pain and hernia recurrence rates did not significantly differ between the two methods. Conclusion: The sub-lay mesh technique in open ventral hernia repairs showed advantages in reducing suction drain duration and wound complications compared to the on-lay mesh technique. However, both techniques had similar outcomes regarding chronic pain and hernia recurrence. Recommendation: Further research with larger sample sizes is recommended to confirm these findings and guide evidence-based practices in hernia repair techniques.

DOI: 10.5281/zenodo.10968975

Background: Second stage of labour starts from full dilatation of cervix i.e 10 cm to delivery of the fetus. Second stage caesarean sections results in much maternal and fetal morbidity. World widely nearly 10-20% deliveries require interventions like caesarean delivery and instrumental delivery. WHO recommends an ideal caesarean section rate between 10-15%. Now a day there is an increase trend in caesarean sections. Objective of this study is to determine rates and feto maternal outcome in caesarean sections done in 2^nd stage of labour. Method: This is a prospective observational study done in all women with singleton pregnancy at term (>37wks) at victoria government hospital from august 2022 to august 2023 regarding maternal outcome and neonatal outcome in cases of caesarean section in second stage of labour. Results: Total number of deliveries during this period is 5850 of which 3528 are vaginal deliveries 2252 are by caesarean sections. Section rate in this hospital is 38.29%. Out of 68 cases that are included in this study depending on inclusion and exclusion criteria, 54 cases are primigravida (79.41%). In this study most common indication is non-progression of labour (55.8%). Most common post-operative complication is febrile episode. Neonatal outcomes in this study are 66 live births and 2 still births. Mean birth weight is 2.8 kg. Conclusion: Caesarean sections performed in second stage of labour are technically difficult due to deeply engaged fetal head in pelvis leading to difficult head delivery. Increase incidence of atonic PPH, extension of uterine incision, tears of LUS is due to thinned out and over stretched lower uterine segment, increased wound infection, post-operative fever, prolonged catheterisation in the post-operative period is observed.

DOI: 10.5281/zenodo.10968983

Objectives: This study was specifically designed for evaluating paranasal sinusitis among the pediatric population. We aim to identify the rare cases of mucus retention cysts or mucocele among pediatricians. Methodology: This retrospective study was conducted in Gadag Institute of Medical Sciences, Gadag, Karnataka.Total 450 cases were recruited within two years of study follow-up. Data was collected from 2018-2020. Patients above ten years were omitted. On the other hand, patients with acute rhinosinusitis, chronic sinusitis, allergic fungal sinusitis, Choanal Atresia, nasal polyps, Mucocele, and fibrous dysplasia were included a definition of paranasal sinusitis. CT scans were performed to evaluate the medial mucosa thickness and presence of concha bullosa. The 3mm or more than 3mm thickness of mucosa was defined as sinusitis, whereas concha bullosa was defined as pneumatization of both lamellar and bulbous parts of the middle turbinate. Complete information related to endoscopic sinus surgery was also observed in research. To evaluate the correlation between the disease severity and middle ear problems, otological examinations were conducted by trained medical staff. Results: In our study, the age range of participants was in between 0- 10 years. In our research, most of the female population demands endoscopic sinus surgery with a mean age of 7.3 years. In our study, we observed three male cases of CSF with a mean age range of 7.3 ± 2.3 years who needs ESS surgery. In this study, CSF was frequently observed in patients above than five-year age group. Conclusion: Our results confirmed the independent relationship between pediatric allergic rhinitis and otitis media. However, mucocele in the pediatric population is very rare. Slow growth and asymptomatic symptoms of mucocele need long longitudinal prospective studies rather than retrospective ones.

DOI: 10.5281/zenodo.10968993

Background and Aim: Perioperative pain in children is a significant consideration, and caudal block is a safe and effective method for managing pain in paediatric patients. When combined with general anaesthesia, it can lead to reduced need for other medications, improved postoperative pain relief, and quicker extubation. Our main goal was to evaluate the two methods by looking at the effectiveness of pain relief, as shown by the intra-operative hemodynamic parameters. We aimed to compare the two techniques by analysing the number of post-operative complications, need for rescue analgesia, puncture count, and duration of each block.
Material and Methods: An investigation was carried out on 100 patients aged between 6 months to 5 years, who were split into two groups (Group A and Group B) of 50 patients each, undergoing elective lower gastrointestinal and genito-urinary tract surgeries over a two-year period in a tertiary care hospital. Results: On average, it took 11.45 ± 8.50 minutes to complete the block procedure. Most patients experienced mild discomfort in both study groups within the first hour after surgery. By the sixth hour, most patients were calm and at ease. At the 12th and 24th hour, most patients were relaxed and comfortable, with similar results in both groups. In group A, 48% of patients needed rescue analgesia, while 52% of patients in group U did not require it. However, this difference was not statistically significant. Conclusion: The caudal block is a commonly used regional anaesthesia technique in children. Using the traditional landmark-based method is simpler and quicker than the more modern ultrasound-guided approach, which requires specialised skills.

DOI: 10.5281/zenodo.10969000

Background: Metabolic syndrome is a multifaceted condition characterized by a cluster of cardio metabolic risk factors. This retrospective observational study aimed to examine the prevalence of hyperuricemia in individuals with metabolic syndrome and explore the association between hyperuricemia and various metabolic syndrome characteristics. Methods: Data were collected from subjects who visited a tertiary care hospital between March 2018 and February 2023. Participants were selected based on the availability of serum uric acid measurements and documented information related to metabolic syndrome criteria as prescribed in National Cholesterol Education Program Adult Treatment Panel III 2005 (ATP III) guidelines. Descriptive statistics and phi coefficient were employed for data analysis. Results: Out of 300 subjects, 186 (62%) subjects had hyperuricemia. Among patients with metabolic syndrome and hyperuricemia, the majority had hypertension (74%), hyperglycemia (42%), dyslipidemia (38%), and abdominal obesity (48%). In contrast, 114 (48%) metabolic syndrome patients without hyperuricemia had lower prevalence rates for these characteristics: hypertension 66(58%), hyperglycemia 46(40%), dyslipidemia 32(28%), and abdominal obesity 43(38%). Conclusion: The Phi coefficients indicated a moderate positive association between hyperuricemia and hypertension, while the associations with hyperglycemia, dyslipidemia, and abdominal obesity were relatively weak. These findings suggest that hyperuricemia may play a role in the development and manifestation of certain characteristics in individuals with metabolic syndrome, particularly hypertension.

DOI: 10.5281/zenodo.10969009

Introduction: Tuberculosis is one of the leading infectious causes of death worldwide wherein lymphadenopathy is the most frequent presentation of extra pulmonary tuberculosis. The usual site of presentation for EPTB lymphadenopathy is cervical region. Among various methods used to diagnose EPTB, conventional methods used are FNAC and ZN staining. The advanced methods used are CBNAAT, Truenat etc. Objective: To assess the reliability of Fine Needle Aspiration Cytology (FNAC) over Cartridge Based Nucleic Acid Amplification Test (CBNAAT) for the diagnosis of Tuberculous lymphadenopathy. Materials and Methods: The present retrospective study was conducted in the department of Pathology, Govt Medical College, and Ananthapuramu. It included all suspected Tuberculous Lymphadenopathy cases irrespective of age except for the cases which were already on treatment and those without CBNAAT/FNAC findings during the period from July 2022 to June 2023. Additionally, test reports of AFB staining, histopathology and culture were also noted. Results: 117 cases in total with both FNAC and CBNAAT reports were analyzed, out of which 69 cases in FNAC showed features of either Granulomatous or necrotic smears and those were taken as positive. 71 cases in CBNAAT showed positive for tuberculosis. Composite reference standard was used for statistical comparison of FNAC and CBNAAT data which showed similar predictive Validity for both. Conclusion: In areas where advanced techniques such as Gene expert are not readily available, easily accessible FNAC can be used as a primary diagnostic tool for EPTB lymphadenopathy cases. Even in centers with advanced diagnostic facilities, basic cytopathologic investigation must be combined with gene expert techniques to avoid false positive and false negative results.

DOI: 10.5281/zenodo.10969019

Background: Intertrochanteric fractures (ITFs) in general were clinically presented as one among the common hip fractures that is predominantly reported among elderly population especially patients suffering from osteoporosis condition and due to low-energy trauma by falls, they had been typically caused. The Proximal Femoral Nailing (PFN) was attributed as quite effective in the ITF treatment due to the recent advancements in the fixation surgery approaches. This study intends to conduct a detailed post-operative assessment on ITF patients with the prime objective of analysing the differences many patients having their treatment with proximal femoral nailing with the help of simple 3-D Gait analyser’s Helen Hayes Protocol. Methods: The study on postoperative observation in Jawaharlal Nehru Medical College, KAHER, Belagavi India was conducted among in and outpatients of orthopaedics. In order to assess the ITF spatiotemporal parameters, the study’s been directed between ITF patients under examination during their post-operative with the help of 3-D Gait analyser by employing the protocol of Helen Haley between January 2021 to December 2021. Statistical analysis was conducted using SPSS (Version 19), for analysis of the data rendered. Results: From the observed investigation, number of males was high in the sample population (56.7%) than female (43.3%). It is observed that type 3 IT fractures was presented and 18 respondents with Type 2 fracture and also 10 with severe Type 4 IT fracture. The gait parameters temporal findings had concerned that there is a rise in the single and double support phase indicatives of the impact of IT fracture on the limbs at their gait. Therefore, the difference could be observed in the gait score from the report. In the deviation of gait score, an abnormal range had been reported as 85.57 ±3.04 (< 100). Conclusion: One of the effective diagnostic tools is 3D gait analyser that could be employed in devising the most suitable management approach as well as treatment modality post-surgery. Furthermore, PFN had been reported for exhibiting the beneficial outcome when the gait analysis is considered from the spatio-temporal findings.

DOI: 10.5281/zenodo.10969029

Background: The study aimed to analyze the occurrence of Cystoid Macular Edema (CME) after small incision cataract surgery in the context of age-related ocular conditions, focusing on postoperative outcomes and associations with diabetic status. Objective: To investigate CME incidence, particularly in the postoperative phase, and evaluate its association with diabetic status. Methods: Inclusion and exclusion criteria were set to maintain a uniform patient population. A sample size of 325 was determined based on calculated CME incidence. Pre-operative evaluations were conducted, followed by small incision cataract surgeries. Postoperative follow-ups occurred at specific intervals (1st week, 6th week, 12 weeks, and 6 months). Diagnosis of CME was established through OCT assessments. Statistical analyses were performed using SPSS software. Results: None of the patients developed CME in the first postoperative week. Incidence increased by the 6th week, notably higher in diabetic individuals. The association between diabetes and increased CME risk was statistically significant. Conclusion: The study identified a distinct escalation of CME post-surgery, particularly in diabetic patients. Tailored postoperative care and vigilant monitoring for diabetic individuals are crucial in mitigating the impact of CME on visual outcomes.

DOI: 10.5281/zenodo.10969069

 

Background: In perimenopausal women, abnormal uterine bleeding (AUB) is a common cause of affecting the quality of life in an otherwise healthy woman. AUB could be only clinical symptom of an underlying pathology such as carcinoma or premalignant endometrial hyperplasia. Proper therapy is only possible when underlying cause of AUB is accurately diagnosed. Endometrial biopsy has long been considered to be gold standard for diagnosis of AUB. The objective of the study was to analyze different histopathological lesions of the endometrium responsible for AUB in perimenopausal women. Methods: A two-year prospective study was conducted in a tertiary care hospital of Punjab, which included 264 cases of clinically diagnosed AUB in perimenopausal age group. Endometrial tissue collected by sampling procedures such as endometrial biopsy, dilatation and curettage (D &C), and fractional curettage was evaluated b histopathological examination and followed by clinical correlation. Results: The most common clinical presentation was represented by menorrhagia (62%), followed by metrorrhagia (27%) and then polymenorrhoea (06%). Out of 264 cases of AUB, the commonest functional lesion observed in the study was secretory endometrium (35.6%), followed by proliferative endometrium (27.2%). Most common organic lesion responsible for AUB was endometrial polyp (6.4%), followed by chronic endometritis (4.5%). Endometrial hyperplasia was seen in 18 cases. Endometrial carcinoma was detected IN 06 cases in the study. Conclusion: Our study revealed that atypical uterine bleeding in perimenopausal women is most commonly dysfunctional in origin. In addition, a significant number of cases of AUB have underlying organic lesions like hyperplasia and malignancy and thereby highlighting the need of endometrial histopathological workup in cases of AUB in perimenopausal women.

DOI: 10.5281/zenodo.10969135

Introduction and Objective: Polycystic Ovarian Syndrome also called as PCOS or PCOD (Polycystic Ovarian Disorder) This disorder is an endocrinopathy, and that’s why it should be referred to as PCOS, a syndrome rather than a disease. Amenorrhoea, weight gain, hirsutism, diabetes mellitus, hypertension, cardiovascular disease, cerebrovascular disease, breastmilk expression in absence of pregnancy and infertility are some of the clinical manifestations caused by PCOS. The objective of this study was to observe the various hormonal and biochemical factors that influence PCOS in the Barak valley region of Assam. Methodology: A total number of 20 cases of reproductive age group of 18-38 yrs were selected for the study fulfilling the following criteria’s: USG > 12 antral follicles and clinical complaints and findings with anovulation and hyperandrogenism Glucose estimation was done by GOD POD (glucose oxidase peroxidase). The tests were carried out in semiautomated biochemistry analyser (ERBA Transasia) HBA₁c estimation was done by Turbodyne SC Tulip and hormonal analysis was done by Classic radiance semiautomated CLIA plate analyser. Free testosterone was done from outsource. Results: 7 cases are hypogonadotrophic and 13 cases are normogonadotrophic subjects who presented with polycystic ovaries. High TSH was found in 15.4% high LH/FSH ratio in 61.5% high prolactin in 69.2%, low prolactin in 15.4% high AMH in 84.6% and high insulin in 30.8% of cases The status of ANOVA shows a significant p value of <0.05 for LH and insulin. High AMH and high LH/FSH ratio were responsible for PCOS. Conclusion: Hormonal abnormalities hamper the normal folliculogenesis, hence needs corelation and correction.

DOI: 10.5281/zenodo.10969147

Background: Skin diseases encompass a wide array of pathologies influenced by genetic, environmental, and socioeconomic factors. Accurate diagnosis is paramount for effective management, with histopathological examination serving as the gold standard. Despite advances in diagnostic modalities, histopathology remains gold standard for a definitive diagnosis. Methods: The study was conducted in Department of Pathology, KAP Viswanatham Government Medical College Trichy, and Tamilnadu over a period of 1 year from July 2022 to June 2023. Skin biopsies from 169 patients of all ages were analyzed. Histopathological techniques, including routine staining and special stains, were employed for in depth analysis. Results: The study exhibited a diverse age range >50 years being most frequently affected, with a male predominance. The trunk was the most commonly affected site, followed by the extremities. Non-infectious diseases were predominant, with vesiculobullous dermatoses and spongiotic/psoriatic dermatoses being the most common. Granulomatous diseases, malignant tumors, and adnexal tumors were also observed. Leprosy emerged as the most common granulomatous lesion with Fite farraco stain positive, while squamous cell carcinoma and basal cell carcinoma were the predominant malignant tumors. Discussion: Findings were consistent with existing literature, highlighting the varied nature of skin lesions and the necessity of biopsy for accurate diagnosis. The age and sex distribution of patients, as well as the prevalence of different types of skin lesions, were discussed in relation to previous studies. Conclusion: Our study of 169 skin biopsy samples revealed a significant prevalence of infectious lesions and vesiculobullous disorders, with Leprosy and Bullous Pemphigoid being prominent. In conclusion, despite advancements in molecular and genetic techniques, histopathological analysis remains pivotal in diagnosing skin lesions and inflammatory conditions.

DOI: 10.5281/zenodo.10969151

Introduction: Premenstrual syndrome (PMS) is one of the most common disorders in women at reproductive age that could significantly interfere with activities of daily life. As per retrospective community surveys nearly 90% of women have experienced PMS at least once in life time. Thus the study was conducted to analyse the effects of BMI on PMS and Premenstrual Dysmorphic Disorder (PMDD). Aims and Objectives: To assess the frequency of PMS and PMDD among menstruating women and to determine the association between BMI, PMS and PMDD. Materials and Methods: A cross sectional study was conducted in 268 women in September, 2023. Each one of them were given a Premenstrual Symptom Screening Tool (PSST) questionnaire through with PMS and PMDD was screened and diagnosed, BMI was calculated and association was analyzed statistically between BMI, PMS and PMDD. Results: The mean age of subjects studied was ± SD: 22.35±5.29 and mean BMI was found to be ± SD: 21.95 ± 3.70. Prevalence of PMS and PMDD was 56% and 28.4% respectively. However the P value of 0.556 indicated that the influence of BMI on PMS is statistically insignificant and P value of 0.992 shows that influence of BMI on PMDD is insignificant as well. Conclusion: Although there is no significant relation between BMI and PMS .The overweight young females had the highest percentage of severe form of PMS and the lowest percentage of mild forms of PMS while the young females with normal BMI had the highest percentage of mild symptoms and the lowest percentage of severe symptoms of PMS. Thus PMS has a negative impact on quality of life in menstruating women.

DOI: 10.5281/zenodo.10969160

Background: The efficacy and safety of intravenous anaesthetics can be significantly influenced by patient-specific anatomical variations. Understanding these influences is crucial for optimizing anaesthetic management and improving patient outcomes in surgical settings. Objectives: This study aims to assess the impact of anatomical variability, including body mass index (BMI), liver size, and vascular complexity, on the pharmacodynamics of intravenous anaesthetics, and to evaluate how these factors affect hemodynamic responses, recovery times, postoperative pain management, adverse effects, and patient satisfaction. Methods: We conducted an observational study involving 100 patients undergoing elective surgeries. Patients were categorized based on BMI, liver size (assessed via ultrasound), and vascular complexity. We measured the onset of anaesthesia, duration of action, clearance rates, hemodynamic stability, recovery times, opioid requirements, incidence of adverse effects, and patient satisfaction scores. Results: Patients with higher BMI and larger liver sizes experienced delayed onset and prolonged duration of anaesthetic effects, along with slowed clearance rates. Those with higher vascular complexity exhibited more significant variability in hemodynamic responses and increased incidence of intraoperative hypotension. Recovery times and opioid requirements were also influenced by these anatomical factors, with higher BMIs and larger liver sizes leading to prolonged recovery and increased pain management needs. Adverse effects and patient satisfaction varied significantly across the different anatomical groups, highlighting the importance of individualized anaesthetic management. Conclusions: Anatomical variability significantly influences the pharmacodynamics and clinical outcomes of intravenous anaesthetics. Tailoring anaesthetic management to individual patient characteristics can enhance efficacy, safety, and satisfaction.

DOI: 10.5281/zenodo.10969165

Background and Objective: General Anaesthesia with endotracheal intubation is a frequent cause of airway mucosal trauma which results in the post-operative sore throat (POST) with an incidence of 21-65 %. Although minor and self-limiting complication, it produces significant discomfort and annoyance to the patient. This study was aimed to compare the efficacy of nebulized dexamethasone versus ketamine in preventing POST. Material and Methods: Present study included 60 patients of ASA I to II, posted for general anaesthesia with endotracheal intubation. Patients were divided into two groups of 30 patients each. Around 15 min prior to the intubation, patients of Group K were nebulised with ketamine (50 mg) and patients of Group D were nebulised with dexamethasone (8 mg). Pulse rate and mean arterial pressure were recorded at specific time intervals. Occurrence and severity of POST, Occurrence of PONV and Post-operative cough were assessed post operatively at specific time intervals. Results: occurrence of POST was significantly less in Group D as compared to Group K at 2,4 and 6th hour postoperatively (p value <0.05). severity of POST was significantly less in Group D as compared to Group K at 2nd ,4th and 6^th hour post operatively (p value<0.05). Although, statistically insignificant PONV is less in Group D compared to Group K. Regarding post-operative cough, it was comparable at 0, 2nd, 4th, 12th and 24 hr post operatively. No patients have experienced hoarseness of voice. Hemodynamic parameters like pulse rate and mean arterial pressure were comparable in both the groups. Conclusion: Pre-operative single dose of nebulized dexamethasone 8 mg effectively attenuates occurrence and severity of POST, with stable hemodynamics following GA with endotracheal intubation than nebulized ketamine 50 mg. Pre-operative single dose of nebulized dexamethasone 8 mg reduces occurrence of PONV and post-operative cough following GA with endotracheal intubation than nebulized ketamine 50 mg.

DOI: 10.5281/zenodo.10969169

Introduction: HIV is a dreadful disease in present society. However, everyone is not infected (even after Transfusion of Contaminated blood). There must be something protecting the infection in some of the individuals of given population. It is likely that the blood groups of an individual may be playing this role. Aim: The present work is carried out to find whether HIV infection is correlated to blood groups of an individual. Materials and Methods: The study was conducted between 2021-2023. Institutional Human Ethical approval has been taken. A total of 451 controls and 912 HIV infected individuals subjects were investigated for blood group status. Blood grouping is done by slide method. Results: Cross tabulation and Analyses were done using the non-parametric chi-square test (p-value two sided) p value of < 0.05 was considered statistically significant. Conclusion: When ABO blood group system is correlated with HIV infection, blood group ‘B’ individuals are more prone to develop HIV infection and blood group ‘AB’ individuals are least affected. HIV infection is not related to inheritance of Rhesus factor. These results infer that the severity of the disease in HIV infection is modified by the genetic constitution.

DOI: 10.5281/zenodo.10969178

Background: Proximal humerus fractures always remained a challenging problem for most orthopedics surgeons due to the high incidence of complications. The majority of undisplaced proximal humeral fractures can be treated with a sling immobilization and physical therapy, however, approximately 20% of displaced proximal humeral fractures require surgery. The surgical modalities use arc transosseous suture fixation, closed reduction and percutaneous fixation, open reduction and internal fixation with conventional plates, locking plate fixation, and hemiarthroplasty which have shown to have mixed results. Material and Methods: The study was conducted in the Department of Orthopaedics, Amaltas Institute of Medical Sciences, Dewas, for a period of one year from January 2023 to December 2023. In our study 30 patients were included aged 18 to 75 years of either sex were included in the study. Results: We studied 30 patients with proximal humerus fractures. The mean age of the patients was 52.4 years. The male-to-female ratio was 3:2. The Mode of injury was by RTA in 18 (60%) patients and fall at ground level in 12 (40%) patients. The average surgical duration was 91+11.3 minutes. The radiological union was seen at 13+4.1 weeks. Results assessed with the Shoulder Function Index Scoring System 70% have achieved excellent and satisfactory results, 26.7% average, and 3.33% poor results. Conclusion: The PHILOS plate has multidirectional screws, which will lead to more stable internal fixation of fracture fragments and helps in the early mobilization of the patients. The repair of the RC ensures functional restoration of the tuberosity, Secondary reduction loss is rare if fixation is stable. An aggressive dedicated rehabilitation regime including ROM exercises and strengthening exercises will ensure a good functional outcome.

DOI: 10.5281/zenodo.10969184

Background: The Placenta Accreta Spectrum (PAS) involves abnormal placental attachment to the uterine wall, exacerbated by rising cesarean section rates. Effective management in rural settings requires early diagnosis through ultrasound and MRI, and a collaborative care approach. Methods:  A retrospective analysis at a tertiary care center from January 2015 to December 2019 assessed PAS prevalence, types, management, and outcomes in 60 patients. The study utilized medical records for data on demographics, PAS type, treatment methods, and outcomes, employing both descriptive and inferential statistics. Results: The cohort showed high multiparity, with PAS types identified as accreta (40%), increta (35%), and percreta (25%). Antenatal diagnosis occurred in 80% of cases, with cesarean hysterectomy being the main treatment (70%). Significant maternal morbidity, including blood loss and ICU admissions, was noted, alongside generally positive fetal outcomes. PAS severity and prior cesarean deliveries were linked to increased maternal morbidity. Conclusion: Managing PAS in rural settings is challenging, requiring early detection and interdisciplinary strategies. The study underscores the importance of careful surgical planning and reducing non-essential cesarean deliveries to mitigate PAS risks. Recommendation: Enhancing diagnostic tools and establishing team-based protocols are essential in rural care centers to improve PAS patient outcomes.

DOI: 10.5281/zenodo.10969190

Aims and Objectives: This study was undertaken to evaluate a comparison of anatomical landmark v/s USG guided technique for superior laryngeal nerve block to facilitate awake fiberoptic intubation with predicted difficult airway-a randomized interventional study at SMS medical college and hospitals, Jaipur. Material and Methods: The Hospital based randomized comparative interventional study was conducted at S.M.S medical college and attached group of hospitals, Jaipur. The study was conducted in following two groups of patients. GROUP A (n=30/group): Patients received 2 ml of 2% lignocaine injection via anatomical landmark guided technique to block bilateral SLN. GROUP B (n=30/group): Patients received 2 ml of 2% lignocaine injection via USG guided technique to block bilateral SLN. Results: There was statistically significant difference between the mean PR, SBP, DBP and MAP in two groups starting from after block which was significantly lower recorded in group 2 then group 1. Mean quality of airway anaesthesia was 1.98 in group 1 and mean quality of airway anaesthesia was 0.97 year in group 2. Mean NRS was 2 in group 1 and mean NRS was 1.09 year in group 2. Mean duration of intubation was 5.26 in group 1 and mean duration of intubation was 1.05 year in group 2. There was statistically significant difference between two groups in terms of quality of airway anaesthesia, NRS and duration of intubation distribution. Conclusion: Using ultrasound in the longitudinal orientation to identify the greater horn of the hyoid bone and the thyroid cartilage as landmarks, combined with an out-of-plane technique, may be an alternative method for ultrasound-guided ibSLN block. However, more studies are necessary to prove the reliability of the new method, especially in live patients.

DOI: 10.5281/zenodo.10969199

Background: Sickle cell anemia (SCA) is a severe genetic disorder that necessitates frequent red blood cell (RBC) transfusions, potentially leading to alloimmunization. This study investigates the association between multiple RBC transfusions and the development of alloantibodies in SCA patients at a tertiary hospital in Jharkhand, aiming to enhance transfusion strategies and patient outcomes. Methods: A retrospective cohort analysis was carried out on 62 SCA patients who received two or more RBC transfusions within the last year. Data on transfusion history, alloantibody presence, and clinical outcomes were collected from electronic health records. Logistic regression models, adjusted for age, gender, and comorbid conditions, were used to analyze the association between the number of transfusions and alloantibody development. Results: Among the patients (54.8% male, mean age 29.4 years), 29.0% developed alloantibodies. A significant correlation was found among the number of transfusions and alloantibody development (p < 0.01), with patients receiving more than five transfusions showing a threefold increased risk. Alloantibody-positive patients were more likely to have a history of acute chest syndrome (p = 0.03) and frequent hospitalizations (p = 0.05). Logistic regression confirmed transfusion frequency as an independent predictor of alloantibody development (Odds Ratio = 3.2, p = 0.005). Conclusion: The study highlights a significant link between multiple transfusions and alloantibody development in SCA patients, underscoring the need for careful transfusion management and monitoring. Recommendations: Implementing antigen matching protocols and leukoreduced blood products could minimize the risk of alloimmunization. Further research is needed to develop targeted therapies for SCA patients at high risk of alloimmunization.

DOI: 10.5281/zenodo.10969205

Introduction: Intra-articular displaced fracture of the calcaneus is the most common of all tarsal fractures (60%) and accounts for almost 2% of the fractures in adults. Approximately 75% of the tongue-shaped calcanea! Fractures are intra-articular and occur due to an axial load such as a fall from height or a motor vehicle accident. All these techniques have certain steps in common including disimpaction of the fragments, reduction of the displaced fragments either manually or percutaneously and protection of reduction with pins and plasters, external fixation or open reduction, and internal fixation. Material and Methods: this was a prospective study that was done at the Department of Orthopedics, MGM Medical College, and MY hospital, Indore. Between September 2018 to September 2021. The patients that were included in the study had calcaneum fractures, were aged 18 years or more, were of both sexes, presented within 2 weeks of injury, close or open grade 1, tongue-type intraarticular fractures of calcaneum included in the study. Results: The mean pre-operative Bohler’s angle improved from 7.74 ± 3.7, to 23.91 ± 8.17 immediately postoperatively and to 23.77 ± 8.32 at the final follow-up of 6 months. The mean Maryland Foot Score was 82.31 ± 7.14 (range 62 to 93). In 16 (26.7%) patients the Maryland Foot Score was excellent, in 38 (63.3%) patients it was good and in 6 (10%) patients it was fair. The mean union time was 10±1.40 weeks (range 8 to 12 weeks). Conclusion: Closed reduction and percutaneous pin fixation are good treatments for tongue-type fractures of the calcaneum. The procedure provided stable fixation and allowed early mobilization. The complication rate associated with the procedure was found to be low. The morphology of the calcaneum improved and was properly maintained in terms of Bohler’s angle.

DOI: 10.5281/zenodo.10969209

Background: Among the elective General surgery procedures performed in a tertiary care Hospital, Inguinal Hernia was found to be the commonest. Hence a demographic audit was undertaken to find out whether it was a major health problem among the elderly individuals in this part of Andhra Pradesh. An attempt was made to study the clinical symptoms, signs and risk factors and final outcome of these procedures on Inguinal Hernia. Aim of the Study: To study the demographic details, risk factors, clinical profile and methods of repair and final outcome in elderly patients with inguinal hernia. Methods: 75 patients diagnosed as inguinal hernia, attending the Department of General surgery of a tertiary care Hospital. Demographic data, symptoms, signs, risk factors and type of surgery undertaken were collected. The final outcome of surgery in all the patients was analysed with a specific note on complications. The study was single center, prospective, non-randomized, analytical study. Results: The Risk factors like Bronchial Asthma found in 14 (18.66%) patients, Constipation in 21 (28%) patients, Low BMI in 08 (10.66%) patients, Family history of hernias in 05 (06.66%) patients and weight lifting jobs in 04 (05.33%) patients. VAS score assessed in 75 patients was 0 to 03 was noted in 18 (24%) patients, 04 to 06 points was noted in 31 (41.33%) patients and 06 to 09 was noted in the remaining 27 (36%) patients. Herniorrhaphy was used as a surgical method to treat inguinal Hernia in 34 (45.33%) patients, in Herniorrhaphy with Mesh was used in 12 (16%) patients; Laparoscopic surgery was used in 12 (16%) patients and MIS Laparoscopic surgery in 16 (21.33%) patients. Conclusion: In the General surgery practice Hernias are most common among the elderly populations. Heavy manual labourers and weight lifters are commonly affected. Swelling, altered bowel habits, pain and irreducibility are common presenting modes. Associated family histories, Bronchial Asthma are common risk factors. Indirect types of hernias are more common.  Herniorrhaphy with or without reinforcement and/ or mesh are commonly performed surgeries. Inguinal hernias are a major Health problem in the elderly patients.

DOI: 10.5281/zenodo.10969215

Background: In the hand and forearm, there are 12 flexor tendons, including finger, thumb, and wrist flexors, with nine tendons within the carpal tunnel (four FDS, four FDP, and one FPL). Flexor tendons are most complex within finger pulleys. Intrinsic healing involves tenocyte proliferation, while extrinsic healing forms adhesions. Preventative methods include precise surgery and early mobilization. Tendon strength stabilizes initially, then substantially increases after 4 weeks. Open flexor tendon injuries, often caused by sharp cuts or crush injuries, are common. This study aims to assess the outcomes of early repair and rehabilitation for acute cut injuries in the hand and forearm flexor zones. Methods: This Retrospective study included forty patients operated for hand injuries. Following initial examination and resuscitation, a thorough assessment of the limb was conducted, encompassing neurovascular, musculotendinous, and skeletal examinations. The integrity or damage of each tendon was evaluated. Specific investigations, including arterial Doppler and Nerve Conduction Studies or Electromyograms, were performed for each patient. Subsequently, patients underwent surgery. Exploration was done and injured tendons, vessels, and nerves were repaired. The hand was kept in a splint and the limb elevated. Physiotherapy and rehabilitation were started at the earliest. Results: In this study, 35% of cases were between the ages of 20 to 30 years. Accidental injury occurred in 35%. The right hand was injured in 50%. Flexor Digitorum Superficialis was injured in 75% and Flexor Digitorum Profundus in 65%. Arterial injuries were at  57.5%. The median nerve was injured in 40% and the ulnar nerve in 35%. 75%of median nerve repairs and 71%of ulnar nerve repairs developed a score of S3 perception. Excellent digital flexion was obtained in 55%. 70% had an active range of flexion of more than 50^o. The average grip strength achieved was up to 80% of normal. 87 % of median nerve and 57% of ulnar nerve repairs achieved M4 & M3 function. 70% returned to work by nine months. Conclusion: Zone V was the most commonly involved. Early repair and postoperative physiotherapy facilitated better outcomes. Injuries of the wrist and forearm showed better functional outcomes and earlier return to work and activities of daily life.

DOI: 10.5281/zenodo.10969221

Background: Seizures are common among pediatric populations, occurring in approximately 10% of children. In most cases, seizures in children are triggered by somatic disorders originating externally to the brain, such as high fever, infections, syncope, head trauma, hypoxia, or exposure to toxins. This study aimed to assess whether children experiencing febrile convulsions exhibit lower serum zinc levels compared to both normal children and children with fever but without convulsions. Methods: The study recruited children admitted with fever to Pediatrics wards of Government Medical College and Hospital, Wanaparthy, Telangana state. We recruited three groups for the study 1) Children with febrile convulsions, 2) Children with fever but without convulsions, and 3) Normal children. Each group consisted of 25 participants. Results: Among children with febrile convulsions, the mean serum zinc level was 41.53 µg/dl, while it was 69.65 µg/dl in children with fever and 71.29 µg/dl in normal children. Statistical analysis revealed significant differences in serum zinc levels among the three groups, particularly between children with febrile convulsions and the other two groups. Statistical analysis found that the mean serum zinc levels were significantly reduced in children with fever and febrile convulsions as compared to normal controls while there were no significant differences in cases of fever without seizures and normal controls. Conclusions: The findings of this study suggest that serum zinc levels are diminished in children experiencing febrile convulsions, indicating a potential role of zinc deficiency in the pathogenesis of these convulsions.

DOI: 10.5281/zenodo.10962592

Objectives: The present study was to evaluate the maternal and fetal outcome of pregnant women who were undergone to vacuum assisted caesarean delivery. Methods: Vacuum deliveries were performed by application of silastic cups. The information related to cervical lacerations, vaginal laceration, perineal tear, episiotomy extensions or paraurethral tear and other maternal outcome were noted.  New-born outcome in terms of Apgar score 1 and 5 min, NICU admissions, convulsions, instrumental injuries or complications (Cephalhematomas, Caput succedaneum, Jaundice, neonatal sepsis) were noted. Results: A total of 200 pregnant women who undergone vacuum assisted caesarean delivery were enrolled. Most of the pregnant women 81(40.5%) were in age group of 21-25 years. Most of the cases 148(74%) were primi gravida. Majorities of the cases had 38- 40 weeks of gestation. Vaginal wall tear 9(4.5%), post-partum hemorrhage 2(1%), 2^nd & 3^rd degree perineal tear 2(1%) and cervical tear 2(1%) were the common maternal complications. Maternal complication rate was 16(8%). APGAR score of 4(2%) neonates at 1 minute had 0-3 and 3(1.5%) neonates at 5 minutes. 18(9%) neonates had 4-6 at 1 minute and 10(5%) neonates at 5 minutes. 32(16%) neonates had required NICU admission. The average NICU stay was 4.23±3.12 days. Most of the common neonatal complication was perinatal asphyxia 10(5%), neonatal depression 8(4%) and hyperbilirubinemia 4(2%). Conclusions: Prolonged 2^nd stage labour, poor maternal effort and fetal distress were the most indication for vacuum assisted caesarean delivery. Vacuum assisted caesarean delivery by a skilled person and a proper technique is found to be safer and associated with lesser maternal and neonatal morbidity and mortality. It should be used with great caution and the delivery be supervised by trained personnel. It is a reasonable option for the obstetrician but the patient must be counselled regarding the risks and benefits of vacuum assisted caesarean delivery.

DOI: 10.5281/zenodo.10962592

Introduction: Marginal adipose tissue invasion (ATI) may lead to a larger contact area between cancer cells and the peritumoral functional lymphatic endothelium increasing the chances for lymphovascular invasion. The prognostic significance of adipose tissue invasion at the tumor margins has not been evaluated fully. Present study is intended to evaluate the adipose tissue invasion at tumor margins, lymphovascular invasion and its prognostic significance in carcinoma breast. Material and Methods: This prospective observational study contain 100 cases of breast cancers, diagnosed as invasive ductal carcinoma NOS were analysed. Clinical and morphological details of cases were recorded according to the proforma. The observations were compared with other studies and inferences drawn. Results: Out of 100 cases analysed, 74 cases showed presence of adipose tissue invasion (ATI). Out of the total cases, 66.2 % belonged to 41-60 years of age. 78.4 % of cases had Bloom-Richardson grade – II. 59 case out of 100 showed lymph node metastasis .62.7 % of node positive cases had adipose tissue involvement. 31.5 % and 22.2 % cases showed positivity for estrogen receptor and progesterone receptor respectively and no statistical correlation was observed between receptor status and adipose tissue invasion. 100% cases of ATI belonged to average to high-risk group according to St Gallen criteria. Case without ATI showed a higher mean 10-year survival rate compared to cases with ATI. 43 % of the present study cases studied showed lymphovascular invasion. Conclusion: Cases which are positive for ATI showed significant increase in lymph node metastasis and a lower 10 years survival rate. Thus, its presence indicates tumour aggressiveness and adverse outcome. Marginal adipose tissue invasion and lymphovascular invasion can be used together as a prognostic marker to predict the tumor aggressiveness and to formulate therapeutic strategies. More studies and investigations are required for substantiating the significance of ATI and its influence in the prognosis of breast cancer.

DOI: 10.5281/zenodo.10962592

Introduction: Catheter-associated urinary tract infection (CAUTI) is the second most common kind of infection acquired in healthcare settings, and it leads to higher rates of morbidity, mortality, and financial costs for patients. The purpose of this research was to evaluate the frequency and different variables that contribute to catheter-associated urinary tract infections. Material and Methods: One hundred and forty cases undergoing Foleys catheterisation were included. Details including duration catheterization, complete clinical history and urine examination details was collected and analysed. Results: Catheter associated urinary tract infection was observed in 44 (31.42%) cases. Around 27.28% of cases showed urinary retention, 2.28% showed incontinence, 40.90% of cases had diabetes mellitus in which 63.63% had suffering with diabetes >8 years. E. coli was commonly isolated microorganism in 34.28% followed by Klebsiella pneumonia 25.71%, Pseudomonas aeruginosa in 15%. Conclusion: Urinary retention, incontinence, diabetes mellitus, duration of catheterization and levels of creatinine were significantly associated with CAUTI (p<0.05). Controlling this illness requires a thorough knowledge of the risk factors involved, which will enable the identification of appropriate interventions to prevent the spread of infection and improve the quality of treatment.

DOI: 10.5281/zenodo.10962592

Introduction: Liver is known as “the custodian of milieu interior”. Hence it is vulnerable to variety of metabolic toxicity, microbial and circulatory insults. It may be primary or secondary to alcoholism, drug toxicity, environmental exposure and habits. Most of liver diseases which are silent in nature are detected incidentally, during work-up for other diseases or diagnosed only at autopsy. We aim to determine the prevalence of silent liver diseases in autopsy examination. Materials and Methods: This descriptive study was conducted in the Department of Pathology and Forensic medicine, Government Medical College, Kottayam. Liver specimens were collected from 150 cases as a part of examination of multiple viscera, over a period of 1.5 years. All the specimen were examined grossly and sections from representative area were submitted for processing, sectioned and stained with Hematoxylin and Eosin stain and special stains in the relevant cases. Results: Out of 150 specimens, we obtained cases with normal liver tissue, inflammatory/ reactive and neoplastic diseases. The lesions reported were steatosis, normal liver, venous congestion, cirrhosis, malignancy, Alcoholic hepatitis, granulomatous lesion, Von Meyenberg Complex and cavernous hemangioma. Maximum cases were in the age group 41-50 years. Liver diseases predominated in males, with male: female ratio of 2.6:1. Steatosis (58.7%) was the most common finding. Conclusion: Silent diseases of the liver are not uncommon. Autopsy examination of liver is very helpful to identify silent liver diseases like fatty change, cirrhosis, venous congestion and rarely malignant tumours.

DOI: 10.5281/zenodo.10962592

Introduction: Urinary catheterization for prolonged period may induce delayed ambulation in patients due to pain and concern of removing the catheter accidentally while moving. It can also increase the colonisation of bacteria in urine, which can lead to UTIs and raise healthcare costs. The present study was designed to assess the advantages of immediate removal versus delayed removal of urinary catheter in the elective caesarean section. Material and Methods: One hundred and thirty-six women between 21-40 years age group undergoing elective caesarean section were randomly divided in to immediately urinary catheter removal group delayed removal after18-24 hours after the caesarean section. Parameters including first postoperative voiding time, ambulation time, significant bacteriuria, patient feedback on catheter usage, and duration of hospital stay were recorded and analysed. Results: The difference of re-catheterization, and dysuria was statistically not significant (p>0.05), while burning micturition was statistically significant (p=0.0167). The first voiding time of urine was 3.98 in group A and 10.2 in group B. Ambulation time was 8 in group A and 18 in group b. The duration of hospital stay was 4.1 days in group A and 5.6 days in group B. Conclusion: The immediate removal of catheter after elective caesarean section is associated with lower risk of urinary infection and earlier postoperative ambulation than the delayed removal.

DOI: 10.5281/zenodo.10962592

Background: Non-traumatic lower limb amputation is a commonly performed surgical procedure and is associated with a high prevalence of psychological morbidity including anxiety and depression. Many risk factors have been identified, including the indication for amputation, perioperative pain and sociodemographic factors. Aim:  The aim of this study was to identify whether level of amputation has an impact on this psychological morbidity. Methods: A prospective observational study was conducted in a tertiary hospital including all adult non- traumatic amputations performed during a 6 month  period.  The  Hospital  Anxiety  and  Depression  Scale (HADS) was used to score anxiety and depression pre and postoperatively. Results: 50 patients met the inclusion criteria – 23 trans-femoral amputations (AKA) and 27 trans-tibial amputations (BKA). HADS scores for anxiety and depression were high in both groups both pre and post-operatively. A higher level of anxiety was noted in the BKA group, significantly decreasing postoperatively (p < 0.05). No other statistically significant differences were found between the two groups. Conclusion: In non-traumatic amputations, there appears to be a higher rate of pre-operative anxiety in patients undergoing trans-tibial amputation compared with trans-femoral amputees. However, the level of amputation does not appear to have a significant effect on psychological status of patients with high rates of depression and anxiety demonstrated in both groups.

DOI: 10.5281/zenodo.10962592

Temporal lobe epilepsy (TLE) is the most common focal epileptic syndrome in population. Mesial temporal sclerosis (MTS) is a frequent structural abnormality in medically intractable TLE. In this study, we aimed quantitative evaluation of epileptogenic focus using interictal diffusion-weighted magnetic resonance imaging (MRI) method in patients with temporal lobe epilepsy. A total of 72 TLE patients who underwent cranial MRI and 35 control cases were included in this study. 34 hippocampal sclerosis (HS) patients and 38 normal patients were evaluated. Patients were divided into two subgroups as MTS+ and MRI-negative TLE. The measurements of ADC were obtained from the hippocampus head, corpus, tail, amygdala, temporal lobe white matter and cortex bilaterally in the axial ADC map and compared between the groups. In the MTS group, predictive cutoff levels of hippocampal ADCs for identifying pathologic areas were established through receiver operating characteristic (ROC) curve analysis. MTS + group had significantly higher ADC values compared to control group, MTS-negative TLE group and contralateral side (p<0.05). We obtained significantly higher ADCs in right hippocampus corpus and tail, left temporal lobe cortex in MRI-negative TLE group than the contralateral side (p<0.05).

DOI: 10.5281/zenodo.10962592

Introduction: Postpartum haemorrhage is the major cause of maternal morbidity & mortality across the world. Every year about 14 million women experience PPH resulting in about 70,000 maternal deaths globally. Obstetric hemorrhage accounts for more than 25% of maternal deaths annually. WHO suggests that 60% of maternal deaths in developing countries were due to PPH accounting for more than 100000 maternal deaths per year worldwide. Objective: The present study was undertaken to study maternal morbidity and mortality in cases of PPH. Materials and Methods: This was a retrospective study conducted in Galaxy Hospital and Venkateshwara Medical College   from October 2023 to Dec 2023 on sample size of 84 patients. Results: The records were analyzed with respect to maternal age, parity, socio-demographic & etiological profile and maternal consequences in cases of PPH at the center. In present study incidence of PPH came out to be 29% due to inclusion of all booked and referred cases Main cause of PPH in this study was uterine atony (69%). Second common cause was traumatic (20%). Incidence of peripartum hysterectomy done for atonic cases was 12.00% and 5.8% in cases of rupture uterus. Blood transfusion was done in 80% of cases. Maternal death due to hemorrhage was 5.3%. Conclusion: Proper anticipation and skilled management, along with timely referral of PPH cases will lead to significant reduction in maternal mortality & mortality, as PPH is a significant contributor to maternal mortality Maternal deaths due to PPH are clearly declining that is due to improved socioeconomic status, high standard medical and surgical management, use of NASG and expert care delivered at our institute.

DOI: 10.5281/zenodo.10962592

Background: Plantar fasciitis (PF) is a common musculoskeletal problem characterized by pain in the heel. Tennis elbow is also known as Lateral Epicondylitis (LE). Tennis elbow is most common musculoskeletal soft tissue injuries mainly seen in adults. The treatment and complete cure from tennis elbow and plantar fasciitis has always been ranked among the most difficult and frustrating problem for both patients and treating doctors. Various forms of conservative treatments are available for tennis elbow and the outcome of these treatments varies in patient to patient. In this study we used intralesional injection of autologous platelet rich plasma for the treatment of tennis elbow and plantar fasciitis. Material and Methods: Present study was single-center comparative observational prospective study, conducted in Department of orthopedics; MGM Medical College and Hospital, Chhatrapati Sambhajinagar during April 2022 to March 2023 were studied. Results: In present study Plantar Fasciitis and tennis elbow patients the mean difference of VAS score found to be statistically significant. At time of PRP injection, in Plantar Fasciitis the mean VAS score 8.76 reduced to 3.17 after 6 months, 4.19 After 3 Months, 5.06 After 2 Months and 6.04 After 1Month. At time of PRP injection, in tennis elbow the mean VAS score 8.42 reduced to 4.47 after 6 months, 5.43 After 3 Months, 6.12 After 2 Months and 6.93 After 1 Month. Conclusion: Autologous platelet rich plasma injection is a safe and useful modality of treatment in the treatment of chronic plantar fasciitis and tennis elbow. The response of patients with plantar fasciitis was significantly better than tennis elbow patients. In Plantar Fasciitis patients, 91.4% patients found PRP treatment was successful whereas in Tennis Elbow patients 85.7% of patients found PRP treatment were successful. Platelet rich plasma injection can be chosen as a non-first-line treatment for plantar fasciitis and tennis elbow patients.

DOI: 10.5281/zenodo.10962592

Background: Spinal anaesthesia is a commonly performed anaesthetic technique. An ideal spinal anaesthetic drug/ drugs for short-duration surgeries should have rapid onset of action and faster offset/ regression of spinal block so as to early discharge and minimal postoperative side effects. In addition, adequate postoperative pain control is one of the most important factor in determining safe discharge after surgery. Hence the present study was done at our tertiary care centre to compare the duration of sensory and motor blockade and complications of chlorprocaine with that of bupivacaine for spinal anaesthesia in obstetric gynaecological procedures. Aims and Objectives: To compare the action of intrathecal hyperbaric 0.5% bupivacaine and 1% isobaric chlorprocaine for spinal anaesthesia in short duration obstetric and gynaecological procedures less than 1 hour. The primary objectives were to compare the onset and duration of sensory block, motor block and the voiding time. The secondary objectives were to compare the hemodynamic effects. (systolic BP, diastolic BP and heart rate). Methods: A hospital based double blind, prospective, randomized study was undertaken on 90 patients to compare the efficacy of intrathecal hyperbaric 0.5% bupivacaine and 1% isobaric chlorprocaine for spinal anaesthesia in short duration obstetric and gynaecological procedures less than 1 hour. Results: The mean duration of motor block was significantly lower for chlorprocaine (107.60±15.48 mins vs 63.81±7.52 mins) (p<0.05). The mean duration of sensory block was significantly less for chlorprocaine (161.61±7.49 mins vs. 81.32±10.06 mins; p<0.05). The time taken for ambulation was significantly more for bupivacaine (263.04±29.08 mins vs. 225.44±29.48 mins; p<0.05). The time taken for voiding of urine was significantly more for bupivacaine (336.13±19.76 mins vs. 276.49±23.99 mins; p<0.05). Conclusion: Chlorprocaine provides satisfactory surgical block, has significantly faster regression of block, earlier ambulation, and voiding, and hence facilitates the faster discharge of the patient from the hospital as compared to intrathecal bupivacaine following spinal anaesthesia in short duration obstetric and gynaecological procedures.

DOI: 10.5281/zenodo.10962592

Background: Menstrual hygiene management (MHM) is a crucial aspect of women’s health, yet it is often overlooked, leading to various challenges for women and girls worldwide. Understanding their experiences, awareness, perceptions, and attitudes towards MHM and safe menstrual products is essential for promoting better menstrual health. Materials and Methods: A cross-sectional study was conducted among women and girls aged 15-49 in urban and rural settings across diverse socio-economic backgrounds. Data were collected through structured interviews and questionnaires focusing on experiences, awareness, perceptions, and attitudes towards MHM practices and menstrual products. Results: Among the participants (n=1000), 72% reported experiencing challenges related to MHM, with inadequate facilities and stigma being the most common barriers. Only 45% of respondents had access to safe menstrual products, while 68% lacked awareness of proper MHM practices. Despite this, 85% expressed a positive attitude towards adopting safer menstrual products and improving MHM practices. Conclusion: The findings highlight the persistent challenges faced by women and girls in managing menstruation safely and hygienically. There is a clear need for comprehensive interventions focusing on education, access to affordable menstrual products, and destigmatization to improve MHM practices and promote menstrual health among women and girls.

DOI: 10.5281/zenodo.10962592

Background: Bilateral superficial cervical plexus block (BSC PB) is widely used for managing pain after surgery, but the ideal dosage of anesthetic agents has to be determined to manage the severity of post-thyroid surgical pain. Method: 60 (sixty) patients were selected for BSCPB with a saline group P (n= 20 patients), Ropivacaine 0.487% Group R (n= 20 patients). Ropivacaine 0.487% plus Clonidine 50μg group RC (n= 20 patients). Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in patients with a bispectral index between 40 and 60. All patients received 4 gm of acetaminophen during the first 24 hours after surgery. The pain score was checked every 4th hourly, and Nefopam was given to reduce pain with scores >4 on a numeric pain scale. Results: The comparison of the mean values of demographic characteristics, age, height, and duration of surgery (minutes) remains insignificant (p>0.001) thus indicating all groups have similar parameters.  The SBP at the end of resection, extubation was statistically significant in group RC (p<0.001). The operative requirement of sufentanil and pain score in PACU were statistically significant in Group RC compared to other groups (p<0.001). Conclusion: In the comparative analysis, it is concluded that group RC (Ropivacaine +Clonidine) was effective in the management of pain reduction and safer to maintain hemodynamic status.

DOI: 10.5281/zenodo.10962592

Background: As recent trend in upper limb surgery is toward outpatient care, brachial plexus blocks have become very popular in effectively providing perioperative anaesthetic and analgesic requirement. Different agent has been added to local anaesthetic for a quicker and excellent intraoperative as well as postoperative analgesia and at the same time reducing the volume of total local anaesthetic used. As an adjuvant, midazolam is known to cause anti nociception and extend the effects of local anaesthetics with some inherent local anaesthetic properties. Purpose of the study was to assess the effect of midazolam as adjuvant, in potentiation of local anaesthetic effects in supraclavicular brachial plexus block. A hospital-based prospective comparative study was conducted after obtaining ethical committee clearance. 30 patients were included in each group using purposive sampling. Group A: Received ropivacaine with preservative free midazolam. Group B: Received bupivacaine with preservative free midazolam. The following parameters were noted: Onset of sensory block, onset of motor block, duration of sensory block, duration of motor block, duration of analgesia, haemodynamic variables, sedation score and complications were assessed. Result: The onset of sensory and motor blockade was significantly faster in group B compared to group A. Again, the duration of sensory and motor blockade was significantly longer in group B compared to group A. The duration of analgesia was also significantly longer in group B compared to group A. Haemodynamic and sedition scores did not differ between the groups in the intra and post-operative period. Complications were almost negligible in both the groups and not significant. Conclusion: In supraclavicular block with midazolam as adjuvant, bupivacaine has an advantage over ropivacaine in terms of early onset of sensory and motor blockade and helps in prolonging the duration of blockade as well as duration of analgesia.

DOI: 10.5281/zenodo.10962592

Background: The present study investigating the relation between vaginal bleeding and adverse maternal and perinatal outcomes in singleton pregnancies in a group of patients with complain of vaginal bleeding in the first trimester. Methods: An observational study with 160 participants from Agartala Government Medical College & G.B.P. Hospital, conducted over 18 months from March 2021 to August 2022, examined cases of vaginal bleeding in early pregnancy. Participants were followed up until delivery, with outcomes categorized into nonviable (abortions, ectopic, molar pregnancies), viable and neonatal outcomes. Results: Most participants were aged 19-24 years (72.5%) and over half were multi gravida (52.5%). First-trimester non-viable pregnancies were primarily abortions (53.75%). Most of the viable pregnancies continued to term (53.45%), often resulting in vaginal delivery (60.0%). Complications included placenta previa (12.07%), preterm labor (10.34%), and least commonly, IUGR (1.72%). Common neonatal issues included low birth weight (38.18%), with stillbirths in (3.45%) and early neonatal deaths in (10.91%) neonates. Conclusions: Bleeding in the first trimester poses risks for both mother and baby. Obstetricians must remain vigilant, recognizing it as a potential harbinger of adverse outcomes. Tailored management strategies and comprehensive prenatal care can mitigate risks, ensuring better pregnancy outcomes and informed decision-making.

DOI: 10.5281/zenodo.10962592

Glycated hemoglobin (HbA1c) is a most preferred test for monitoring of diabetes mellitus patients but it is altered under certain conditions so fructosamine is used as an alternative for short term monitoring of blood glucose levels. HbA1c can be calculated from serum fructosamine. The difference between measured and calculated HbA1c is called glycation gap. This gap is altered under different glycation conditions which may serve as a simple tool to monitor the glycation levels. The aim of the present research study is to compare the serum fructosamine and HbA1c and then to calculate and assess the glycation gap in diabetic patients without complications. In our study, 72 diabetic patients without complications were included and based on serum fructosamine values they are divided into three groups. Serum fructosamine, HbA1c and Hemoglobin were measured. Calculated HbA1c values are obtained using calculated HbA1c-fructosamine regression equation. The difference between measured and calculated HbA1c termed the glycation gap was calculated for all the cases. The relationship between these parameters was graphically analyzed. Mean and standard deviation was calculated for all the 3 groups and one way statistical analysis test was done. The glycation gap was found to be negative in all these cases and statistically significant between the three groups.

DOI: 10.5281/zenodo.10962592

Ionized calcium levels play an important role for identification of disturbances in calcium homeostasis. This is due to the fact that deviation in Serum protein levels and blood pH will alter the Serum total calcium levels. In critically ill patients alteration in protein levels and changes in Blood pH are commonly observed. Ionized calcium concentrations vary inversely with pH. The current research study aims to investigate the ionized calcium levels in various acid base disturbances in critically ill patients. 190 arterial blood sample data’s were utilized. The consistency of the report was verified using Modified Henderson Equation. ABG parameters like pH, pCO2, HCO3, Standard base excess and ionized calcium levels are noted and the predicted Ionized Calcium (at pH 7.4) was calculated. Arterial blood gas analysis revealed 20 normal cases, 8 respiratory acidosis, 50 respiratory alkalosis, 35 metabolic acidosis, 30 metabolic alkalosis and 47 mixed disorder cases. Acid base disorders are divided into 4 groups based on the ionized calcium levels namely≤1 mg/dl, >1.0 ≤ 2.5 mg/dl, >2.5 ≤4.4 mg/dl and >4.4 ≤ 5.4 mg/dl. The Results are tabulated and graphically analyzed. Ionized calcium level is normal in only 4.74 % of the total 190 cases.  Irrespective of the acid base Disturbances ionized calcium level is lowered in critically ill patients.

DOI: 10.5281/zenodo.10962592

Background: The term “spontaneous abortion” refers to abortion that occurs without the use of medical or mechanical means to empty the uterus. Previous instances of spontaneous abortions should be considered high-risk pregnancy because they may result in negative outcomes in the future Pregnancies with low birth weight, preterm labour, intrauterine growth restriction, and subsequent pregnancy loss. The current study goal is to compare pregnancy outcomes in women who have had prior abortions to normal pregnancy outcomes. The effect of emotional support, good antenatal care supplemented with ultrasound in early pregnancy gives success rates. Methodology: This was a prospective comparative study done at a tertiary care hospital-Government Maternity Hospital, Tirupati, Andhra Pradesh, India for 1year period in 200 cases. Conclusion: Women who suffer an initial miscarriage are more likely to experience some obstetric and perinatal issues than women who have a successful initial pregnancy. There is association between previous spontaneous abortion and PROM, IUD in subsequent pregnancies. The likelihood of a successful result declines as the number of prior abortions rises.

DOI: 10.5281/zenodo.10962592

Context:  With growing evidence supporting the beneficial role of antidepressants in improving the prognosis of COVID-19 infection, and possibly even prevent infection, this study was taken up in the outpatient setting. Aim: Our goal was to assess the prevalence of COVID-19 infection among patients on antidepressants, and to compare it with that in the control group along with illness and treatment variables. Settings and Design: 50 patients attending Psychiatric Department, SVRRGGH, Tirupathi (tertiary care centre) who were on regular antidepressant medication for a minimum of 3 years (3 months at time of any reported COVID-19 infection) were evaluated as the antidepressant group, along with their corresponding informants as the control group who were not on any psychotropic drug at any point of time. Material& Methods: This was done as a hospital based cross-sectional study on the antidepressant and control group as defined above. Each subject was administered a semi structured questionnaire including details of socio-demographic variables, specific details regarding history of COVID-19 infection, its course, vaccination status. Statistical analysis used: The data was analysed using Chi-square test and t-test. Results: 12% of those in the antidepressant group had a history of COVID-19 infection as opposed to 16% of those from the control group (confirmed via a positive RT-PCR report). Conclusions: According to the study’s findings, the prevalence COVID-19 infection was found to be  more in the control group, than in those on antidepressants.

DOI: 10.5281/zenodo.10962592

Aims: (1). To estimate the seroprevalence of TTIs in both healthy and voluntary donors at tertiary care hospital in India. (2). To know the burden of TTIs in the community and to plan effective measures in preventing them. Methods: The present retrospective study was held between 2018-2019, a 2 year study done at the blood bank of Chamrajanagar Institute of Medical Sciences, a tertiary care hospital in India. Data regarding prevalence of TTIs like Hepatitis B, Hepatitis C, HIV, syphilis and malaria among both voluntary and replacement donors tested by appropriate methods were retrieved from blood bank records. Statistical analysis was done on seroprevalence of TTIs in blood donors. Results: A total of 5750 voluntary and replacement donors were screened for TTIs. Overall seroprevalence of TTIs among blood donors was 45 (0.78%), among them 42 (93%) donors were males and 3 (7%) of them were females. Most common age group of blood donors was found to be between 31-40 years. The overall seroprevalence of Hepatitis B, Hepatitis C, HIV, syphilis and malaria among the blood donors in present study were 0.4%, 0.09%, 0.14%, 0.1% and 0.03% respectively. Conclusion: Thus the present study concludes that sero-prevalence of transfusion transferable infections are on decreasing trend which is a great sign. However risk of transmission still occur during window period of infections, due to high cost of testing methods, lack of trained staff or testing errors. Diligent donor selection is the prime factors to increase blood safety and to reduce transfer of infected blood. 

DOI: 10.5281/zenodo.10962592

Background: The treatment of urinary stones has undergone a remarkable evolution in the last 15yrs. Open surgeries have given way to minimal invasive procedures which have considerably decreased patient morbidity and mortality. With the advent of various Endourological and percutaneous technique the management of Urolithiasis has become much easier. Aim: The Aim of the study is to know the different ways of clinical presentations & complications of Urolithiasis, to know the incidence of Urolithiasis at different anatomical levels in the urinary tract, the outcome of the different modes of management of Urolithiasis. Methodology: prospective observational study in patients with Urolithiasis attending Surgical OPD and/or getting admitted under the Department of Surgery at PESIMSR between September 2013 and August 2015, satisfying the inclusion and exclusion criteria. Results: Out of 130 cases, 45 (35%) were female and 85 (65%) were male (ratio of 1:2). Nearly 70% cases were between ages 15-50. Pain Abdomen was the most common symptom, presenting symptom. Right sided calculus was more common than the left. The lower 1/3 of ureter/ vesico-ureteric junction was the most common site of calculus affecting in 73 (56.1%) cases. The size of the calculus ranged from 6mm to 50mm (mean 10.5mm). Diabetes Mellitus was the most common co-morbidity among the study patients, seen in 31 (23.8%) patients. Urine culture showed growth in 36 (27.6%) patients. Most common organism was E. coli seen in 21 (16.1%) cases, followed by Staphylococcus in 8 (6.1%), Klebsiella species in 5(3.8%), and Streptococcus in 2 (1.5%) cases. Ureteroscopy was done in 95 (73.1%) cases, PCNL in 18 (13.8%) cases and both URSL+PCNL/DJ in 1case (0.8%), CLT done in 14(10.8%) cases. 1 vesical stone was extracted by open cystolithotomy and 1(0.8%)case extracted by PB CLT in urethra. Conclusion: In the past the urinary stone disease used to affect the lower urinary tract more commonly. This trend has also changed in the past few decades with higher number of cases presenting with renal and upper ureteric stones. Urolithiasis presents most commonly as abdominal/loin pain. This may be associated with vomiting, nausea, fever, burning micturation etc. A huge number of predisposing factors affect the formation of urinary calculus.

DOI: 10.5281/zenodo.10962592

Introduction: The peroneus tertius is a muscle of extensor compartment of leg .It is a unipennate muscle originating from lower third of fibula, anterior surface of interosseous membrane and anterior intermuscular septum, insertion of the muscle is on dorsal surface of base of fifth metatarsal. The peroneus tertius acts as dorsiflexor and evertor of foot. The presence of peroneus tertius is important for dorsiflexion and extension of the foot in swing phase of the gait. Aims and Objectives: Presence of peroneus tertius in human and absence of it in other primates is an evidence of evolution and supports its function of terrestrial bipedalism, so the knowledge of presence or absence of peroneus tertius is imperative from clinical and academic point of view. Material and Methods: This study was carried out between 1^st October 2019 to 31^st October 2020.A total of 25 cadavers (50 lower limbs) were studied. Dorsum of the foot was dissected following standard incisions and dissection procedures. Results: Out of the 25 cadavers (A total 50 lower limbs) peroneus tertius was found to be absent in 7 lower limbs, bilaterally in 2 of the cadavers and absent unilaterally in 3 of the cadavers. Conclusions: Peroneus tertius provides proper aid to the lateral border of sole and its absence may weaken the support given by the muscle. Also its tendon can be used for transplant in foot drop surgeries.

DOI: 10.5281/zenodo.10962592

Background: Young women experience certain difficulty in coping up with premenstrual tensions commonly. It has few destructive effects on their behaviour, activity and interpersonal relations with their friends. Premenstrual syndrome is one of the common menstrual disorders in adolescents. It is important to be watchful of the destructive effects due to these effects especially on medical students. Aim of the study: To study the role of demographic data, risk factors and to determine the certain factors playing a role on the prevention of premenstrual tension syndrome among the medical students. Materials: A cross sectional voluntary survey was performed in a Medical College and Tertiary Hospital among the 278 female medical students. The data included demographic details, and obtaining answers to a valid and reliable questionnaire pertaining to the behavioral changes and their role on preventive methods. Statistical analysis: SPSS software version 16 was used for both descriptive and logistic regression. Results: 54 (19.42%) students were mild mannered, 37 (13.30%) were aggressive, 127 (45.68%) were with a positive attitude towards life, 24 (08.63%) students were with a negative attitude of life and 36 (12.94%) students were depressive. The grading of the psyche was ‘Always’ in 51 (18.34%), ‘often’ in 56 (20.14%), ‘sometimes’ in 92 (33.09%), ‘rarely’ in 42 (15.10%) and ‘never’ in 37 (13.30%) of the students. The mean (SD) score of adoption of preventive behaviors of premenstrual syndrome was 19.25 (0.63) out of 50, and it was low. Also, knowledge of PMS, regular physical activity, parent’s education level, was the factors affecting the adoption of preventive behaviors of premenstrual syndrome (P < 0.05). Conclusion: The prevalence of PMS was high among the medical students. The PMS was observed more commonly among the aggressive, depressive and negative type of personalities. The adoption of PMS was poor among the students who were inactive in physical activity. The adoptive measures to prevent PMS were good with students whose parents had higher education, students with regular physical exercise and in students who had knowledge of PMS.

DOI: 10.5281/zenodo.10962592

Background: Spinal anesthesia is a safe and effective alternative to general anesthesia when the surgical site is located on the lower extremities, perineum (eg, surgery on the genitalia or anus), or lower body wall (eg, inguinal herniorrhaphy). Objective: To compare post spinal (SAB) haemodynamic changes (hypotension and bradycardia) between two groups. Methods: This Prospective observational study was conducted in Department of Anaesthesiology and Critical Care in M GM Medical College and LKS Hospital. ASA physical status II, between 18 to 40 years of age, parturient undergoing elective caesarean section at term was enrolled in this study. Study period was August  2022- August 2023. Results: Intra-Op pulse rate was less in Normal Saline group compared to Ondansetron group which was statistically significant. Intra-op lowest SBP, DBP and MAP were less in Normal Saline group compared to Ondansetron group which were statistically significant. Episodes of bradycardia in intra-op were more in Normal Saline group compared to Ondansetron group though it was not statistically significant. The mean Episodes of hypotension in intra-op was more in Normal Saline group compared to Ondansetron group which was statistically significant. Conclusions: Use of intravenous ondansetron before sub-arachnoid block in parturients undergoing caesarean section, causes significant reduction of hypotension and variable reduction of bradycardia intra operatively.

DOI: 10.5281/zenodo.10962592

Background: Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis of acute appendicitis is based on careful history, physical examination, laboratory and imaging findings. The aim of this study was to analyze the role of C-reactive protein (CRP) in improving the accuracy of diagnosis of acute appendicitis and to compare it with the histopathology findings. Methods: This was a retrospective study on 100 patients surgically treated for acute appendicitis. The measurement of CRP was randomly collected pre-operatively from 100 patients. Pre-operatively CRP level were correlate with appendix diameter. Results: Mean CRP level in 0-6 mm appendix diameter patients was 1.61 ±2.42 mg/dl, in 6-8 mm diameter cases was 2.84 ±3.52 mg/dl, 8-10 mm cases CRP level was 3.06±3.12 mg/dl and in 10-12 mm diameter cases CRP level was 3.68±2.61 mg/dl. Conclusion: Raised serum C-reactive protein reducing the rate of negative explorations.

DOI: 10.5281/zenodo.10962592

Background: The aim of our study was to study the correlation of COVID 19 severity with D-dimer in RT PCR confirmed cases of COVID 19. Methods: We conducted a Cross sectional analytic study on 180 patients (60 asymptomatic, 30 each with mild, moderate, severe and critical illness) diagnosed with COVID-19 clinically, radiologically and confirmed by RTPCR at Shree Haridev Joshi General hospital and Government medical college, Dungarpur. Total 3 ml of venous blood sample was collected from each subject in Citrate vacutainers. D dimer was estimated on ECL105 coagulation analyzer. Results: The mean ng/ml value of D dimer levels in various group were as follows – 5.87±16.7 in asymptomatic, 7.37±19.2 in mild symptomatic, 76.6±146.8 in moderate illness, 508.9±780.6 in severe and 3275.7±5595.0 in critically ill patients. T-test analysis shows that mean D dimer levels had no statistically significant difference between asymptomatic and mild symptomatic COVID 19 subjects, however in all the subsequent severity groups had significantly high D dimer levels. It can be said that with increase in severity of COVID 19, the D dimer levels also increased. Conclusion: Investigating D-dimer dynamics over time and its correlation with treatment response and long-term complications could provide valuable insights. Exploring D-dimer’s utility in specific patient subgroups or for risk stratification to personalize treatment strategies holds promise. Large-scale, multi-center studies with standardized protocols are crucial to confirm findings and establish generalizable D-dimer thresholds for clinical practice.

DOI: 10.5281/zenodo.10962592

Introduction: Obstructive jaundice, a frequent hepatobiliary disease, presents significant diagnostic and management challenges, particularly in cases of intrahepatic cholestasis. Aims & Objectives: This study aimed to evaluate the diagnostic accuracy of abdominal ultrasound (USG) and CT scan in biliary tract obstruction, comparing them with operative findings. Materials and Methods: The study included patients admitted to the surgery wards of Shri Jagannath Medical College and Hospital, Puri, Odisha, for evaluation and treatment of suspected obstructive biliary tract diseases. Results: Tumors were the most common cause of obstruction, affecting 29 patients (58%), followed by choledocholithiasis (gallstones in the bile duct) in 14 patients (28%) and benign biliary strictures in 4 patients (8%). Ultrasound (USG) exhibited 100% sensitivity and 86.2% specificity in detecting benign lesions as the cause of obstruction, while CT scans achieved 100% sensitivity and 93.1% specificity in the same context. For malignant lesions, USG maintained 86.2% sensitivity and 100% specificity, while CT scans surpassed it with 93.1% sensitivity and 100% specificity. Overall, 10 cases were falsely diagnosed by USG while only 4 cases were falsely diagnosed by CT scan among all 50 cases. Compared to USG, CT scans offer improved sensitivity for detecting choledocholithiasis (gallstones in the bile duct), CBD strictures, and malignant pathologies. While the sensitivity, specificity, and accuracy of CT scan for choledochal cysts are comparable to USG. Conclusion: Ultrasonography (USG) remains the most common initial imaging modality for diagnosing obstructive biliary diseases. However, its sensitivity can be limited for certain conditions, particularly benign strictures and distal common bile duct (CBD) diseases. In such cases, or when clinical and laboratory findings suggest biliary obstruction despite negative or inconclusive ultrasound results, a CT scan becomes a valuable diagnostic tool. Furthermore, CT scans offer superior accuracy for comprehensive malignancy staging.

DOI: 10.5281/zenodo.10962592

Background: Traumatic hollow viscous injuries following road traffic motor vehicle accidents are rising due to urbanisation, modernisation and it is the main cause of morbidity and mortality in Trauma. The aim of this study is to know the factors in traumatic hollow viscous injuries which help in decreasing mortality. Methods: Retrospectively records of all the patients with a history of abdominal trauma due to road traffic accidents and diagnosed as hollow viscous injuries on X-ray abdomen and/or Ultrasound (USG) or/and Computer tomography (CT) were analyzed. Demographic data, mode of injury, mechanism of injury, nature of the injury, presentation to the hospital, hemodynamic stability, investigations, definitive treatment required and the outcome of patients were recorded. Results: There were 32 patients of abdominal trauma with hollow viscous perforation with male to female ratio of 4.3:1. Mean age was 33.61±14.61 years.8 (25%) cases reached hospital 6 hours after abdominal injury. Blunt abdominal trauma was seen in 29 (90.6%) cases.  Surgical interventions were required in all 32 (100%) cases. Most common were small bowel injuries (56.3%) followed by colon (25%). Surgical intervention in bowel consisted of laparotomy and simple closure of perforation in 12 (37.5%) patients, resection and anastomosis in 15 (46.88%) patients and stoma in 3 (9.3%). Closure of urinary bladder done in 2 (6.3%) patients. 3 patients (9.3%) of abdominal trauma with hollow viscous perforation succumbed to death. Among the factors leading to mortality, delayed presentation, hemodynamic instability, requirement of transfusion, resection and re-explorations were common. Conclusion: Delayed presentation and management, hemodynamic instability, site, mechanism of injury, resection and re-explorations are the factors deciding outcome in traumatic hollow viscus injuries.

DOI: 10.5281/zenodo.10962592

Background: Urinary tract infection is common among children of significant concern in paediatric healthcare. The study was designed to KNOW the prevalence, clinical, microbial profile and antibiotic susceptibility pattern of uropathogens isolated. Methods: This is a hospital based prospective observational study done in the department of pediatrics, Vijay Marie hospital, Hyderabad over a period of 9 months from February 2023 to October 2023.The study was accepted by institutional ethics committee. Written and informed consent was obtained from children’s parent. Children in whom urine culture was sent based on significant urine microscopic finding among the admitted patients were included in the study. Results: A total of 134 patients were included in the study, out of which 74(55.22%) was culture negative, 19(14.17%) was with insignificant colony count and 41(30.59%) was culture positive. Among culture positive cases 13(31.7%) were males and 28(68.3%) were females. The clinical features observed were fever (95.12%), cry while micturition/dysuria (12.19%), diarrhoea (19.5%), abdominal pain (14.63%), vomiting (29.26%), seizures (9.75%) and cough/cold (12.19%). Elevated CRP was seen in 80.48% children and leucocytosis in 34.14% cases. The most common organism isolated was  coliconstituting 75.6% followed by Klebsiella 9.75%, proteus 4.87% and morganella, enterococci and CONS 2.43% each. 40 culture positive case was started with ceftriaxone as first line empiric antibiotic therapy except one, which started with amikacin from outside hospital. 16(39%) were ESBL, in which 12(75%) responded to ceftriaxone within 48hrs of antibiotic and 2(12.5%) responded within 72 hours of antibiotic therapy and in 2 cases antibiotic upgraded to Piperacillin-Tazobactam based on sensitivity pattern, since there was no response after 72hrs of treatment. Conclusion: Prevalence and isolates of culture positive UTI cases was similar to that reported in literature. Most common symptoms with children presented was fever, vomiting, abdominal pain, diarrhoea and cry while micturition/dysuria.it was observed that even though there is increased ESBL organisms and increased invitro resistance to cephalosporins there is in vivo sensitivity. Hence cephalosporins can be continued as a first line empiric antibiotic treatment.

DOI: 10.5281/zenodo.10962592

Background: Urinary tract infection is common among children of significant concern in paediatric healthcare. The study was designed to KNOW the prevalence, clinical, microbial profile and antibiotic susceptibility pattern of uropathogens isolated. Methods: This is a hospital based prospective observational study done in the department of pediatrics, Vijay Marie hospital, Hyderabad over a period of 9 months from February 2023 to October 2023.The study was accepted by institutional ethics committee. Written and informed consent was obtained from children’s parent. Children in whom urine culture was sent based on significant urine microscopic finding among the admitted patients were included in the study. Results: A total of 134 patients were included in the study, out of which 74(55.22%) was culture negative, 19(14.17%) was with insignificant colony count and 41(30.59%) was culture positive. Among culture positive cases 13(31.7%) were males and 28(68.3%) were females. The clinical features observed were fever (95.12%), cry while micturition/dysuria (12.19%), diarrhoea (19.5%), abdominal pain (14.63%), vomiting (29.26%), seizures (9.75%) and cough/cold (12.19%). Elevated CRP was seen in 80.48% children and leucocytosis in 34.14% cases. The most common organism isolated was  coliconstituting 75.6% followed by Klebsiella 9.75%, proteus 4.87% and morganella, enterococci and CONS 2.43% each. 40 culture positive case was started with ceftriaxone as first line empiric antibiotic therapy except one, which started with amikacin from outside hospital. 16(39%) were ESBL, in which 12(75%) responded to ceftriaxone within 48hrs of antibiotic and 2(12.5%) responded within 72 hours of antibiotic therapy and in 2 cases antibiotic upgraded to Piperacillin-Tazobactam based on sensitivity pattern, since there was no response after 72hrs of treatment. Conclusion: Prevalence and isolates of culture positive UTI cases was similar to that reported in literature. Most common symptoms with children presented was fever, vomiting, abdominal pain, diarrhoea and cry while micturition/dysuria.it was observed that even though there is increased ESBL organisms and increased invitro resistance to cephalosporins there is in vivo sensitivity. Hence cephalosporins can be continued as a first line empiric antibiotic treatment.

DOI: 10.5281/zenodo.10962592

Background: Neonatal period is the most vulnerable period of human life for diseases and most of these are preventable. Globally important causes of neonatal mortality (NNM) are prematurity, birth asphyxia and sepsis in low income countries whereas, prematurity and malformations are leading causes of death in developed countries. Aims: The present study was aimed to describe the current clinical spectrum of morbidity and mortality of neonates admitted in NICU of a service hospital. Material and Methods: The study was a hospital based prospective observational study conducted over a period of one year from May 2015 to June 2016 in Department of Neonatology in which 195 Neonates admitted in NICU of our hospital during the study period were included in study. Results: Common morbidity seer was respiratory distress (57.4%), neonatal jaundice (28.7%), Neonatal sepsis (16.9%), NEC (4.1%), birth asphyxia (14.9%), hypoglycemia (5.1%), apnoea (9.2%), neonatal seizures (9.7%), congenital heart disease (12.8%), Retinopathy of prematurity (5.6%) and surgical intervention (7.2%). Conclusion: respiratory distress in preterm neonates, neonatal jaundice, and Sepsis & birth asphyxia are leading causes of morbidities in neonates. Maternal history of preterm delivery, bad obstetric history, Rh Isoimmunization should be discussed among Obstetrician and Pediatrician and planned accordingly. Outcome of birth asphyxia cases can be favorable causing less of mortality with timely and appropriate neonatal resuscitation interventions.

DOI: 10.5281/zenodo.10962592

Aim: The objective of this study is to analyze the cause and risk factors in obstetric patients admitted to the intensive care unit of a tertiary care. Materials and Method: It is a retrospective study of obstetric cases (pregnant & postpartum <42days) admitted to the obstetric ICU over a period of 2years from January 2020 to December 2021 in a tertiary care center in West of India. Results: During the study period about 251 patients were admitted to obstetric ICU. Maximum patients were admitted in age group of 21 – 30 years, 55.37% patient were referred from other centres apart from parent place, both primi & multigravida were admitted which was approx. 43%, majority of patients were admitted in 3rd trimester followed by in postpartum period. Amongst the admitted patient highest number of patients were admitted due to anemia followed by eclampsia, septicemia, APH, covid 19 infection and PPH. Maximum patients required blood transfusion which was 80.07%, followed by surgical intervention, inotropic support & ventilatory support. Maximum number of maternal mortalities were due to septicemia followed by Hemorrhagic shock & COVID 19 pneumonia. Conclusion: Common risk factors for ICU admission are severe anemia, hypertension, septicemia, APH, PPH, Heart disease & COVID 19 pneumonia due to COVID 19 pandemic.

DOI: 10.5281/zenodo.10962592

Introduction: Laparoscopic cholecystectomy is a gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Operative grading has recently been reported to define disease severity and few have also been validated. The aim of this study was to assess an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy and evaluated the associated risk factors. Methods: A total of 105 patients of sexes (male-66, female-39), aged 18-80 years and socio-economic status were included in this study. All routine investigations and USG (Ultrasonography) were done. Risk factors assessed were age, sex, abdominal tenderness, gall bladder wall thickness, any history of para-umbilical surgery. Clinical evaluation was also done for each included patient and two scoring systems (World Society of Emergency Surgery -WSES-WG-10 [4] & Randhawa- GR-15 [2] were employed according to their signs and symptoms. Patients were categorised subsequently into easy (group 1), difficult (group 2) and severe (group 3) difficulty as per scoring method. Results: The  mean age of the patients was 51.02 ± 11.26 years (range, 18–80),(95 % CI 47.56 to 49.86) with 39 females and 66 males; females were aged 49.45 ± 12.81 years (range, 21–73), whereas males were aged 52.60 ± 13.12 years (range, 23–79). Among the converted group, 6 (5.71%) participants were ≥ 60 years of age and 3 (2.85 %) participants were of age ≤ 60 years. According to patient’s expected level of difficulty in laparoscopic cholecystectomy and according to scoring system, patients were categorised as easy, difficult and severe. A total of 56 (53.33%) patients were categorised as easy, 40 (38.09%) as difficult and 9 (8.57%) as severe. Conversion rate was 0 % in easy group, 1/2.5 % in difficult group and 9/100 % in severe group. In this study, the conversion rate from laparoscopic to open cholecystectomy was 8.57%. It was also found that at a preoperative cut-off mean score of ≥ 6. 84, the sensitivity and specificity for predicting easy cases were 88.2% and 73.8%, respectively, and had an accuracy of 88.6% for easy cases and 68.5% for difficult cases. RG-15 could be used with some factors as GB wall thickness ≥ 4mm, age≥ 60 years, BMI≥ 27.5, Leucocyte count ≥ 10.000µl for future. Conclusion: This intraoperative scoring system was effective and accurate. Additionally, it signified the need for conversion from laparoscopic to open cholecystectomy in cases of severe cholecystitis.

DOI: 10.5281/zenodo.10962592

Aim: The aim of the study was to evaluate the prevalence of non-carious cervical lesions (NCCLs) in patients reporting to dental OPD of a tertiary care centre in M.P. Material and Methods: A descriptive cross-sectional study was conducted on a sample of 775 patients during October 2022 to December 2022. The patients were evaluated for the demographic characteristics, prevalence of NCCLs and oral health practices. Results:  The male to female ratio of the study population was 1.37:1. The maximum number of the participants (25.29%) belonged to 26-35 years age group. The overall prevalence of NCCLs in the study population was 20.51%, while most affected age group was 56-65years (50.57%). Maxillary premolars were the most commonly involved teeth (30.71%) followed by mandibular premolars (22.75%). Conclusion: NCCLs were more common in male patients and in maxillary teeth. The lesions were more prevalent in patients who reported their tooth brushing intensity to be hard or those who were using hard toothbrush. Recommendations: NCCLs may pose a major health burden on patient. Focus should be laid on promoting appropriate oral health practices and good dietary habits since the occurrence of NCCLs is largely preventable.

DOI: 10.5281/zenodo.10962592

Background: Primary open-angle glaucoma (POAG) is a chronic progressive optic neuropathy characterized by elevated intraocular pressure (IOP) and subsequent visual field loss. The use of anti-glaucoma medications is a common strategy to manage IOP; however, their impact on ocular surface health is increasingly recognized. Aim and Objective: This study aimed to investigate and compare ocular surface parameters between POAG patients on anti-glaucoma medication regimen and treatment-naïve individuals. Materials and Methods: Fifty participants diagnosed with POAG were enrolled in this prospective comparative study. Group A comprised 25 POAG patients on anti-glaucoma medication regimen, while Group B consisted of 25 treatment-naïve POAG patients. Ocular surface parameters including tear film stability, ocular surface staining, conjunctival hyperemia, and tear osmolarity were evaluated and compared between the two groups. Results: Significant differences were observed in various ocular surface parameters between Group A and Group B. Medicated POAG patients exhibited reduced tear film stability (p < 0.001), higher corneal and conjunctival staining scores (p < 0.001), increased prevalence of severe conjunctival hyperemia (p = 0.021), and elevated tear osmolarity (p = 0.008) compared to treatment-naïve individuals.
Conclusion: The findings highlight substantial ocular surface alterations associated with anti-glaucoma medication regimen in POAG patients. Clinicians should consider the impact of medications on ocular surface health when managing glaucoma, with potential implications for treatment strategies aimed at minimizing adverse effects while effectively controlling IOP and preserving visual function.

DOI: 10.5281/zenodo.10962592

Introduction:  COVID-19 infection is caused by SARS-CoV-2 virus. Pregnant women being in an immunosuppressive state are more susceptible to COVID-19 infection leading to many complications like severe illness, ICU admission, need for ventilator support and death. COVID-19 vaccination during pregnancy reduces the risk of severe illness and complications from COVID-19 infection in the mother. COVID-19 vaccination builds antibodies that protects the baby also. The main objective of this study was to compare the safety and efficacy of COVID-19 vaccination in pregnant and non-pregnant women. Materials and Method: 50 pregnant and 50 non pregnant women were given 2 complete doses of covaxin/covishield. Adverse events following vaccination and neutralizing antibody titre before and after vaccination was compared between the pregnant and non-pregnant women. Results: The mean age in pregnant women was 24.22 and in non-pregnant women 29.34. P-value< 0.001 which was statistically significant. 43 pregnant and 46 non pregnant women received covaxin. 7 pregnant and 4 non pregnant received covishield. P value 0.523 not statistically significant. After the 1st dose, 12 pregnant women and 15 non pregnant women complained of minor adverse events. P-value 0.652 was non-significant. After the 2nd dose, 10 pregnant women and 14 non pregnant women developed minor adverse events. P-value 0.482 was non-significant. Mean pre vaccination titre in pregnant women was 55.96 and in non-pregnant women 73.53. P-value< 0.001 was statistically significant. Mean post vaccination titre in pregnant women was 78.83 and in non-pregnant women 79.44. P-value 0.799 not significant. Pre and post vaccination titre was compared between the two groups The antibody hike was 22.9% in pregnant women and 6.1% in non-pregnant.. P value was statistically significant. Conclusion:  COVID-19 vaccination is completely safe and well tolerated by pregnant women. Vaccination in pregnant women results in immunogenicity and reactogenicity similar to that observed in non-pregnant women.

DOI: 10.5281/zenodo.10962592

Background: Irritable bowel syndrome (IBS) was described as a not uncommon GIT disease with a Psycho-somatic pattern. It was considered as the most common functional GIT disorder. Nearly 50 85% of individuals with IBS suffer from psychiatric illness also. Aim of the Study: To list out the co-morbid psychiatric conditions in patients with IBS and their management and its effect on IBS. Methods: A cross sectional study was conducted at Kannur Medical College, Anjarakandy, Kannur, Kerala between Jan 2023 and June 2023. 57 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. 30 subjects who were attendants of the patients and healthy were considered as the controls. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, Mini International Neuropsychiatric Interview Schedule Plus was used. Results: Among the 57 patients the mean age of our IBS patients was 41.23 ± 09.25 years and among the control group the mean age was 40.51± 3.4 years. There were 19 males (15.78%) and 38 (19.29%) females with a male to female ratio of 1:2.  Among the controls the male to female ratio was 1:1.72. In the IBS group 08 (08.77%) patients were educated below intermediate, 17 (12.28%) up to intermediate, 24 (24.56%) were graduates, 08 (08.77%) were post graduates. There was no significant difference between the IBS and control groups in regards to Age,  employment, social status and marital status (p value more than 0.05) But in regards to Gender, education and BMI there was significant correlation statistically (p value less than 0.05). Conclusions: Most of the patients with IBS have different types of co-morbid psychiatric disorders. Among the patients with IBS-M the commonest psychiatric conditions were MDE and GAD. To achieve better outcome in IBS patients, screening the patients for psychiatric conditions to be undertaken and also develop a holistic approach.

DOI: 10.5281/zenodo.10962592

Background:  Fractures of the forearm constitute 35% and 45% of all pediatric long-bone fractures. Despite of increasing trend in operative treatment for pediatric forearm fractures, closed fractures of the forearm in children are often treated with closed reduction and immobilization in a well-fitting plaster cast and achieve a satisfactory outcome in a majority of patients, The goal of the treatment is to restore appropriate length, alignment & rotation which will allow normal function after remodeling and healing is completed. Material and Methods: 30 patients with forearm fractures of the pediatric age group attending the OPD and emergency of the Department of Orthopedics, MGM MC, and MY hospital, Indore who met the inclusion criteria outlined below were recruited in the study. All children between 2 to 13 years of age, fractures undergoing closed reduction of radius and ulna fractures, no other associated fractures, and informed consent included in our study. Results: In our study, we included 30 patients from age 2 to 13 years (Mean age – 7.38 years). Out of these patients, 12 were males and 18 were females. 10 patients who were lost in follow-up after close reduction and cast application were excluded from the study. The mean follow-up in our study was 6.4 weeks. The mean cast index is 0.858 with a range of 1.004 -0.65. In our study, we noticed complications of Re-displacement in 3 patients (cast index range of 0.75-0.97) and nonunion in one case (cast index -1.004). Conclusion: CI is a simple, reliable, and objective radiological measurement to determine the quality of molding and padding of the plaster thereby predicting the Re-displacement of fractures in this group.

DOI: 10.5281/zenodo.10962592

Pregnancy imposes significant physiological demands on women, particularly those with pre-existing heart disease. This review synthesizes current literature on the pregnancy outcomes of women with heart disease, focusing on the risks, challenges, and management strategies. We systematically examined studies published between 2017 and 2022, identifying key factors influencing maternal and fetal health during gestation and delivery. Pre-existing heart conditions such as congenital heart defects, valvular disorders, and cardiomyopathies pose unique challenges, necessitating a multidisciplinary approach involving obstetricians, cardiologists, and anesthetists. While advancements in medical care have improved outcomes, pregnant women with heart disease remain at heightened risk of complications such as heart failure, arrhythmias, and maternal mortality. Strategies including risk assessment, preconception counseling, tailored medication regimens, and close monitoring are essential in optimizing outcomes. This review underscores the importance of comprehensive care, early intervention, and individualized management plans to mitigate risks and promote favorable pregnancy outcomes in women with heart disease.

DOI: 10.5281/zenodo.10962592

Introduction: The objective was to study the diagnostic efficacy of components of individual and combined modified triple test in breast lump. Materials and Methods: This was a prospective, analytic, clinical study had included 72 Female patients with palpable breast lump/lumps above 12 years of age, who were admitted in surgery Outpatient  Department and ward from June 2017 to May 2018 with breast lump/lumps. Patients were informed about procedure of clinical breast examination, ultrasonography of bilateral breast with axilla and fine needle aspiration cytology of the breast lump. Results: Most common age group in this series was 50 to 70 years of age. Mean age was 36.74 ± 14.88 years. The most common symptom was lump in axilla 8 (11.11%) along with breast lump, more on Left side 41 (56.94%), most commonly upper outer quadrant 41 (56.94%), size of lump was in range of > 2 cm to 5 cm in diameter 57 (79.17%) patients. In clinical examination with benign pathology in 36 (50.00%) and malignant pathology were found in 36 (50.00%). Ultrasound of bilateral breast with bilateral axilla yields that 37 (51.39%) patients had malignant pathology and 35 (48.61%) patients have had benign pathology. FNAC yields malignant pathology 39 (54.16%) and lump with benign pathology were found 33 (45.83%). Modified triple assessment with specificity 100.00% sensitivity 88.89%, positive predictive value 100.00%, Negative predictive value 85.65% and Accuracy 93.52% in diagnosis of palpable breast lump. Conclusion: The diagnostic accuracy of combined clinical breast examination, breast USG and FNAC was comparable and reliable to that of histological examination.

DOI: 10.5281/zenodo.10962592

Background: Sperm morphology is a crucial aspect of male fertility, impacting reproductive success. This study delves into the evaluation of a simplified and cost-effective staining method for accurate sperm morphology assessment, addressing the challenges associated with conventional techniques. Materials and Methods: This study was conducted at St. John’s Medical College, Bangalore, with three adult male subjects. The methodology included meticulous sample collection, preparation, and staining of prestained methylene blue slides, emphasizing simplicity and rapidity. Results: In this study clear visualization of the sperm morphology was achieved. Notably, the stain facilitated the distinct observation of the sperm structure, including the clear identification of the nucleus, middle piece, and tail. Conclusion: Staining advocates for widespread adoption of this simplified technique, particularly in primary health care settings. The paper contributes to enhancing accessibility and affordability in sperm morphology evaluation.

DOI: 10.5281/zenodo.10962592

This study assesses the drug use patterns among orthopedic patients in Dr. D.Y. Patil Medical College, Navi Mumbai, focusing on the number of drugs per encounter, the ratio of injectable to oral drugs, and the utilization of anticoagulants, analgesics, and antibiotics. A cohort of 100 patients was analyzed over six months, revealing a median of 4.5 drugs prescribed per patient encounter, with a significant reliance on analgesics (80%) and antibiotics (70%), and a judicious use of anticoagulants (30%). The study found a balanced use of injectable (2 per prescription) versus oral drugs (3 per prescription), indicating a comprehensive approach to pharmacotherapy in orthopedic care.
The prevalent use of analgesics and antibiotics underscores the focus on pain management and infection prevention, respectively, although it also highlights the need for cautious prescribing to mitigate risks associated with opioid use and antibiotic resistance. The inclusion of anticoagulants in post-operative care protocols reflects an evidence-based approach to preventing thromboembolic events, critical in orthopedic surgery outcomes.
Patient outcome measures indicated an average hospital stay of 5 days, with a complication rate of 10% and a readmission rate of 5%, suggesting the effectiveness of the current pharmacotherapy strategies while also pointing towards areas for potential improvement. The findings emphasize the importance of evidence-based prescribing, patient education, and ongoing monitoring to enhance patient safety and outcomes in orthopedic care.

DOI: 10.5281/zenodo.10962592

Background and Aim: The coverage of vaccination in India is far from complete despite the commitment for universal coverage. Reasons for lack of coverage vary from logistic ones to those dependent on human behavior. Present study was done with an aim to determine immunization status of children in age group 2 to 5 years admitted to Tertiary care hospital and to study the factors which influence the immunization status. Material and Methods: A Cross-Sectional Observational Study was carried out in which children between 2 to 5 years’ age admitted to paediatric department of a tertiary care hospital were included. Information on socio demographic factors and immunization history was collected. Immunization status of these children was analyzed and the cause for partial and non- immunization were studied. A total 380 children fulfilling the inclusion criteria were included in the study. Results: Out of 380, 266 (70%) children were completely immunized and remaining 114 (30%) children were non/partially immunized. The immunization rate being highest (77.5%) in the 2 to 3 year’s age group followed by 3 to 4 year’s (70.7%) and 4 to 5 year’s age group (60.8%). The numbers of completely immunized children were more in the urban area (71.9%) compared to rural area (62.3%). Birth order, place of delivery, presence of immunization card, socio-economic status, father and mother’s education and employment status were statistically associated with immunization. Conclusion: Lack of knowledge about immunization was the most common reason given by the caretakers for incomplete or no immunization. Other common reasons were ‘child not well’ at the scheduled date of immunization, fear of untoward effects, no information about place of vaccination, and child gone to native place at scheduled date of vaccination.

DOI: 10.5281/zenodo.10962592

Background and Aim: Evidence seems to suggest that dysfunction in many biological functions is associated with major depressive disorder (MDD). Literature suggests a possible link between different lipid parameters and depression. The study aimed to compare the serum lipid parameters of psychiatric depressed patients undergoing therapy with those of normal controls. Material and Methods: The investigation was conducted over duration of one year. A cohort of 100 individuals diagnosed with depression, aged between 25 and 50 years, were chosen from the Psychiatry outpatient department. The control group of the study included one hundred healthy individuals who were matched based on gender and age group and did not have depression or use any other medication. The levels of serum total cholesterol (TC) and triglycerides (TG) were determined using spectrophotometry on an auto analyzer. The measurement of HDL-C was conducted using the Dextran sulphate Mg2+ precipitation technique. The calculation of LDL-C was performed using the Friedwald equation. Results: The average age of the patients included in the study group was determined to be 30.22 ± 08.10 years, whereas the age in the control group was determined to be 33.89 ± 07.22 years. The average HDL cholesterol level of 100 participants in the study group was 49.62 ± 15.76 mg/dl, whereas it was 45.23 ± 2.12 mg/dl for the 100 participants in the control group. The average total cholesterol (TC) level of 100 participants in the study group was 180.12 ± 32.98 mg/dl, whereas it was 220.43 ± 79.29 mg/dl for the 100 participants in the control group. Conclusion: Individuals diagnosed with Major Depressive Disorder exhibit a greater occurrence and frequency of hyperlipidemia compared to the general population. Individuals with serum lipid profile abnormalities are at an increased risk of developing cardiovascular disease.

DOI: 10.5281/zenodo.10962592

Background: Musculoskeletal disorders have a substantial impact on the overall health of orthopaedic patients; thus, monitoring the development of the correlation between anatomy and functional outcomes is of utmost importance. This correlation is examined through a retrospective cohort study with the aim of acquiring a more comprehensive comprehension of the factors that impact post-orthopaedic healing. Methods: Within two years, 200 orthopaedic patients who had undergone surgery in a tertiary care hospital were analysed. Over time, the research centred on demographics, bone structure, and functional outcomes. In this study, we employed correlation coefficients, multivariate regression, and subgroup analysis to examine the potential association between specific anatomical characteristics and sustained functional recovery. Results: The study examined two hundred orthopaedic patients who underwent surgery within the previous two years. 55% of the population was male and 45% was female, with an average age of 45.2 years. Osteoarthritis (30%) and ligament injuries (15%) constituted the most prevalent musculoskeletal disorders. Ligamentous lesions were observed in 25% of the patients. 78% of musculoskeletal anatomy evaluations were devoted to evaluating joint integrity. Using standardised instruments, it was determined that mobility (90.1), patient satisfaction (4.2), and long-term functional outcomes (85.2) were all rated above average. The bivariate analysis revealed a significant positive correlation (r=0.42, p<0.001) between functional outcomes over the long term and joint integrity. Multivariate regression confirmed the association (β=0.35, p<0.001). Conclusion: This research demonstrates how the musculoskeletal anatomy of orthopaedic patients influences their functional outcomes during treatment. Prolonged functional rehabilitation necessitated the safeguarding of joint integrity. Enhancing patient outcomes requires therapies to be given to anatomical characteristics, as demonstrated by the findings.

DOI: 10.5281/zenodo.10962592

Background: Different female reproductive organs have different shapes and sizes, which affects fertility and the success of pregnancies. Based on past data, this study looked at the uterine, tubal, and ovarian features of 150 different women. Finding out how common and important anatomical variation is in clinical settings was the secondary effect. Methods: This study looked back at imaging data and electronic medical records to find differences in the bodies of 150 women aged 18 to 45. Some women with concerns about their reproductive health were considered to be included, but they were ultimately not allowed to join. We looked into the many links between differences in anatomy and clinical outcomes using logistic regression and chi-square tests. Results: The population under investigation was statistically balanced because the average age was 32 years. In 20% of the cases, bicornuate and septate uteri were seen. An ovarian anovary affected 15% of men and 7% of women, while 15% of women had tubal patency. Problems with tubal patency, infertility, and uterine abnormalities were all linked to having multiple miscarriages. Conclusion: The goal of this study is to find out how often and what kinds of medical effects differences in the female reproductive organs have. Overall, the results show how important personalised approaches to reproductive medicine are for helping doctors provide the best care. Two areas that need more research are the long-term effects of treatments and how genetic and environmental factors can cause differences in body structure.

DOI: 10.5281/zenodo.10962592

Background: The confusing relationship between high blood pressure and chronic kidney disease (CKD) leads to a number of bad health effects. The purpose of this retrospective study is to find out how exercise and changes in living can help people with CKD who have high blood pressure. Methods: A group of 100 people with chronic kidney disease and high blood pressure were studied by experts at Madhubani Medical College and Hospital over the course of a year. The patient’s demographics, blood pressure, lifestyle factors, and exercise habits were all found in their medical data. The statistical studies that were done included looking at the results of the interventions and making descriptive statistics. Results: The study found that the average age was 53, men and women were equally represented. Co-occurring conditions included heart disease (25% of them) and diabetes mellitus (30%). At 140 mmHg systolic and 85 mmHg diastolic, the blood pressure was moderate, according to the descriptive figures. With exercise and following the DASH diet, blood pressure dropped significantly; the combined treatment had synergistic benefits, lowering systolic blood pressure by 15 mmHg and diastolic blood pressure by 10 mmHg. Conclusion: CKD patients whose blood pressure went down were found to have better blood pressure after exercising and making changes to their lifestyle, especially following the DASH diet. The study suggests that the treatment of high blood pressure in people with CKD might be improved by adding exercise and food changes.

DOI: 10.5281/zenodo.10962592

Background: The Acute coronary syndrome (ACS) remains a major cause of illness and death around the world. Novel drugs may work better than well-known medications in treating ACS, so antiplatelet therapy is essential. The long-term effects of a new type of antiplatelet drug on people with ACS are looked at in this study. The results will help doctors and patients make better decisions about treatment and care. Method: Research from Madhubani Medical College and Hospital glanced back at data collected from January 2021 to January 2022 and examined 100 patients who had new antiplatelet treatment for acute coronary syndrome. From electronic medical records, demographic data, details about the treatment, and results were taken. A statistical analysis of the effect of the new antiplatelet treatment on death rates, repeat cardiovascular events, and side effects was carried out. Results: The average age of the patients in the study was 58.3 ± 8.6 years, and half of them were men and the other half were women. Long-term results showed that patients with ACS who got new antiplatelet therapy had almost no recurrent cardiovascular events (15%) or deaths (5%). A small group of patients had bad effects, including stomach problems (8%), hemorrhage (3%), and allergic responses (3%). Conclusion: Our study presents a new antiplatelet drug that gives patients with ACS a safe and effective alternative, which could lead to better long-term outcomes. It is very important to keep researching in this area so that we can improve patient care and find the best ways to treat them.

DOI: 10.5281/zenodo.10962592

Background: Malignant tumours involving Breast affects the physique and psychology of women right from its occurrence and diagnosis. Women undergo emotional and psychological trauma in addition to the suffering from pain and energy draining therapies adopted in its treatment. The body image is also affected in such women that will add upon the psychological trauma. Aim of the Study: To assess the prevalence of psychological conditions and body image disturbances in Breast malignancy survivors following modified radical mastectomy (MRM). Methods: A cross-sectional study undertaken at a tertiary care Hospital of Andhra Pradesh including 42 women who survived malignancy of the Breast following MRM during the follow up period. Demographic data was recorded. Depression, Anxiety and stress in the patients were assessed by using the Depression Anxiety and Stress Scale (DASS-21). A 10 item Body Image dissatisfaction scale was used. All the data was anlysed using standard statistical methods. Results:  The mean age was 43.11± 3.15 years. The mean duration required to complete the treatment protocol in this study was 11.55± 2.45 months. Majority of the patients reported to the Hospital late in their III rd stage (38.09%). The total rate of depression was 73.80%. The total rate of Anxiety was 50% in this study. The total prevalence of stress was 22 (52.38%). The total BID score was 50%. Conclusions: Post MRM patients of Brest malignancies suffer from depression, anxiety and stress in addition to Body image dissatisfaction. Hence every MRM patient should be evaluated properly for psychiatric illnesses and also Body image dissatisfaction. Suitable psychotherapy methods should be initiated as early as possible to avoid grave consequences leading to suicide.

DOI: 10.5281/zenodo.10962592

Background: Though Pregnancy is physiological; it remains as a risk factor for stroke, and hemorrhagic stroke accounting for 60% of the strokes. It may occur during of 6 weeks postpartum period. Intra Cranial Haemorrhage (ICH) has a high case-fatality rate. Women experiencing ICH are at much higher risk for preterm birth. Aim of the Study: to elucidate pregnancy-associated stroke using the Inpatient Sample by estimating the changes in overall pregnancy associated stroke as well as stroke with and without hypertensive disorders of pregnancy; identifying the stroke risk factors play a role in these hypertensive disorders of pregnancy and stroke. Materials: A cross sectional study undertaken with 41 pregnant women who developed spontaneous stroke. Demographic data collected, ICD9 classification used for strokes, investigations done, neurosurgical measures undertaken in all. The course of stay, prognostic data was analysed using standard statistical methods. Results: 41 pregnant women with Spontaneous stroke were included; the mean age was 21.35±2.40 years. 16 (39.02%) women developed IHC due to SAH. Intra-parenchymal Hemorrhage (IPH) was noted in 12 (29.26%), Sub Dural hemorrhage was noted in 09 (21.95%) of the total women. Extra Dural hemorrhage was noted in 04 (09.75%) women. There was no significant relationship between ages, gestational age, status of their gravida, and status of their Para, mode of delivery or admission week after delivery. (P > 0.05). Conclusions:  Spontaneous hemorrhagic stroke is a therapeutic emergency. During pregnancy the maternal and fetal prognosis are involved. The multidisciplinary management allows one to find the best compromise between the requirements imposed by the state of the mother and those related to the presence of fetus.

DOI: 10.5281/zenodo.10962592

Background: Breast cancer is a leading global health issue, particularly affecting women. Fine Needle Aspiration Cytology (FNAC) offers a less invasive, cost-effective, and efficient method for evaluating breast lesions and distinguishing between benign and malignant conditions, playing a crucial role in early detection and management. Methods: A retrospective analysis was conducted over one year at the Department of Pathology, Government Medical College, Rajouri, Jammu & Kashmir. Fifty female patients who underwent FNAC were included, with data collected on clinical history, examination, and FNAC findings, categorized according to the Yokohama system. The sensitivity and specificity of FNAC in the diagnosis of breast lesions were a focal point of the study. Results: Of the 50 cases, 66% were benign, 8% atypical probably benign, 6% suspicious for malignancy, and 20% malignant. Fibroadenoma constituted the largest fraction (38%) of benign lesions. The age of patients ranged from 11 to 70 years, with a mean age of 36.15 years. The majority were aged between 21-30 years. Clinical presentations varied, with 20% reporting breast pain and 10% presenting with nipple discharge. Conclusion: FNAC is a valuable diagnostic tool in breast lesion evaluation, with a high rate of benign findings and the most common benign lesion being fibroadenoma. Recommendation: FNAC should continue to be utilized as part of a multidisciplinary approach in breast lesion assessment, particularly in resource-limited settings, with a recommendation for additional training for cytopathologists to further improve diagnostic accuracy.

DOI: 10.5281/zenodo.10962592

Background and Objectives: Diagnosis of non-alcoholic fatty liver (NAFLD), as a cause of progress towards the end stage of liver disease, is increasing. Increased body fat accompanied with diabetes mellitus, hypertension or changes in lipid metabolism, which is considered a separate disease as “metabolic syndrome” increases risk of cardiovascular diseases. The present study was conducted at tertiary healthcare center to evaluate the clinical, biochemical profile and prevalence of atherosclerosis by measuring the CIMT in Indian patients with incidentally detected NAFLD and to study its relationship with metabolic syndrome. Material and Methods: It was an Observational study conducted among outdoor patients and indoor patients admitted at our tertiary care hospital among 100 non-alcoholic individuals, with age >12 years defined as either total abstainers or who consumed <20 g of alcohol per day (confirmed by two family members) and ultrasound showing hyperechoic liver suggestive of fatty liver. Carotid Intima-Media thickness (CIMT) was assessed by trained professional using high resolution B mode ultrasonography system (Phillips HD 11XE) having an electrical linear transducer mid frequency of 7- 12 Mega Hertz. Results: Total 47% cases were in Grade I, while 43% cases in Grade II and 10% cases were in Grade III. Maximum cases in all grades were aged more than 60 years followed by age group 51-60. The mean CIMT on right side was 0.65 and left side was 0.66. Conclusion: Grade II and III USG findings were comparatively observed more among advanced age groups as compared to lesser age groups. And the mean CIMT on right side was 0.65 and left side was 0.66.

DOI: 10.5281/zenodo.10962592

Background: In many developing countries like India, a culture of silence surrounds the topic of menstruation and related issues; as a result, many young girls are having lack of appropriate and sufficient information regarding menstrual hygiene. This may result in incorrect and unhealthy behavior during their menstrual periods. Objectives: To assess knowledge and impart health education regarding menstruation and menstrual hygiene among adolescent school girls. Methods: A cross sectional study was conducted in two Govt. Senior Secondary Girls Schools, Jhalrapatan. All the eligible girls, aged 10 to 19 years and who have menarche, were included for study. Data was collected by pre-designed Questionnaire which includes socio-demographic information, knowledge about menstruation and menstrual hygiene and general physical examination. At the end of session, concern health education was delivered by LMO. The obtained data was analyzed by using SPSS software. Chi- Square test was used for significant association and p value less than 0.05 was considered as significant. Results: Out of 375 girls, 45.6% girls had good knowledge about menstruation and menstrual hygiene. Mother was found to be the first source of information in most of the girls. Mean age of menarche was 12.78±1.2 years. Regular cycle was reported by 68.8% of girls. Sanitary napkins were used by 84% of girls while clothe was used by 16% of girls. Association of knowledge was found significant with age (p=0.018), class standard (p<0.0001) and literacy status of mother (p=0.012). Religious activities were restricted (66.4%) during periods in both Hindus and Muslims religion. Conclusion: Less than 50% of adolescent girls had adequate knowledge of menstruation and menstrual hygiene. Mother was first source of information in most of girls and it also depends on mother’s literacy status. Taboo’s related to menstruation still persist in the society.

DOI: 10.5281/zenodo.10962592

Background: In this study, we assessed the quality of sleep and the factors affecting it, in adults with traumatic spinal cord injury. Methods: The observational cross- sectional study was carried out for a period of one year in 100 adults with TSCI who satisfied the selection criteria and visited the Department of PMR, at a tertiary care centre, Kerala, India. They were assessed for quality of sleep using the Pittsburgh Sleep Quality Index (PSQI). They were also interviewed and examined for extent of injury and for the presence of specific symptoms or signs peculiar to the study population. The presence or absence of these factors were compared with the quality of sleep to find out if they had any relationship to the same. Results: SPSS version 25 data analyser was used to assess the variables. Chi square test was used to compare the results. On relating with sleep quality, the following factors: (1) AIS status, (2) duration of SCI, (3) flexor spasms, (4) bowel accidents, (5) anxiety, (6) depression, (7) bed mobility and (8) ambulatory ability were found to be of significance, while the factors: (1)extent of injury, (2)pain and (3) spasticity were not found to be statistically significant. Conclusions: (1) 47% of the study population had disturbed sleep with a PSQI score of more than 5. (2) Patients with AIS D were 1. three times more likely to have undisturbed sleep compared to AIS A. (3) Patients with duration of SCI of more than one year were 1.56 times more likely to have undisturbed sleep compared to patients with duration less than one year. (4) Patients with flexor spasm were 3.67 times more likely to have disturbed sleep compared to those without. (5) Patients with bowel accidents were 3.67 times more likely to have disturbed sleep compared to those without. (6) Patients with anxiety were 3.73 times more likely to have disturbed sleep compared to those without. (7) Patients with depression were 8.33 times more likely to have disturbed sleep compared to those without. (8) Patients with bed mobility were 4.88 times more likely to have undisturbed sleep compared to those without. (9) Patients with ambulatory ability were 17.3 times more likely to have undisturbed sleep compared to  those without.

DOI: 10.5281/zenodo.10962592

Background and Aim: Tobacco use, whether it’s smoking or using smokeless products, poses a significant risk for oral disorders. It can lead to various changes in the oral mucous membrane, ranging from reversible lesions like smoker’s palate to the development of oral cancer. Our study aimed to examine the frequency of different mucosal lesions in participants and explore any potential connections with clinicopathological factors. Additionally, we aimed to provide comprehensive data on tobacco use within the study group. Material and Methods: A total of 500 individuals were included in the study, all of whom sought dental care at the Dentistry Department of the Gujarat Adani Institute of Medical Sciences in Bhuj, Kutch, and Gujarat for duration of six months. Information about individuals and their behaviours was collected through a standardised questionnaire administered by an interviewer. A biopsy was performed on the oral mucosal lesions to evaluate their histopathological characteristics and correlate them with the clinical diagnosis. The data was subjected to statistical analysis. Results: A total of 500 patients who were 15 years or older underwent evaluation. Among them were 300 men and 200 women. Men had a higher tendency to smoke, while women preferred chewing tobacco. Oral mucosal lesions made up 18% of the cases. There is a strong correlation between the frequent occurrence of oral mucosal lesions and the widespread use of tobacco-related practices. The most common lesions observed were smoker’s palate, smoker’s palate with melanosis, leukoplakia, and smoker’s melanosis. Conclusion: It was found that 18% of the research population had oral mucosal ulcers related to tobacco use. Furthermore, it was found that there is a higher prevalence of smoking among men compared to chewing, and smoking is associated with an increased incidence of leukoplakia lesions. There are various changes that can be observed, including hyperkeratosis and smoker’s melanosis, as well as premalignant and malignant lesions.

DOI: 10.5281/zenodo.10962592

Introduction: Secretory breast carcinoma (SBC) is a rare (<1%) low grade breast carcinoma. It is the most prevalent breast carcinoma in children. Case Report: A 21 years old male presented in surgery outpatient department with lump in left breast. On examination, a swelling of size 2.5cm x 2cm was observed in left sub areolar region, it was firm, mobile and slightly tender. Ultrasound showed a heterogenous lesion of size 1.9 cm x 1.5 cm near areolar region. Fine needle aspiration cytology (FNAC) smears revealed loosely cohesive sheets, clusters and singly scattered epithelial cells having moderate amount of amphophilic cytoplasm with mild nuclear enlargement in some cells. Background shows inflammatory cells and macrophages. Cytological possibility of gynaecomastia with epithelial hyperplasia, proliferative breast disease or a salivary gland neoplasm was given. An incisional biopsy was performed measuring 1.5 x 1 x 0.5 cm in size which was grey brown in colour. Microscopy revealed a tumor arranged in sheets, nests and tubules with secretions at places which was infiltrated by mild mixed inflammatory infiltrate. The tumor cells were round to oval with moderate amount of cytoplasm. Desmoplastic stroma along with macrophages and cholesterol clefts also seen at places. Immunohistochemistry (IHC) on the biopsy showed positivity for PAS (periodic acid–schiff), S-100 and SMA (smooth muscle actin). Conclusion: SBC are a rare form of breast cancer and even rarer in male children. This case report takes on importance as there are few papers published about this subject hindering the standardization of diagnosis, treatment and establishing a prognosis.

DOI: 10.5281/zenodo.10962592

Background: Superficial Dermatophytosis is an extensively prevalent dermatological condition that significantly affects the quality of life of affected individuals. This study explored the demographic and clinical dimensions of extensive dermatophytosis, emphasising its varied manifestations and the need for personalised management. Aim: To comprehensively assess the impact of extensive dermatophytosis on the quality of life of affected individuals considering diverse demographic and clinical factors. Methods: This questionnaire-based observational study was conducted over 8 months at the Department of Dermatology, Sri Lalithambigai Medical College and Hospital, Chennai. The study included 150 patients aged ≥ 15 years who were clinically diagnosed with extensive dermatophytosis. Demographic details, disease characteristics, and Dermatology Life Quality Index (DLQI) questionnaire responses were also collected. Results: Extensive dermatophytosis in 150 patients significantly impacted quality of life, with a predominant presence in the 21-30 age groups. Sex differences were not statistically significant. Patients with symptoms lasting 6-12 weeks reported a higher impact, and the DLQI scores varied based on marital status, previous treatment, topical steroid use, and dermatophytosis types. Conclusion: The impact of dermatophytosis is influenced by demographic and clinical factors. Despite the limitations of observational studies, it advocates a patient-centred approach that emphasises tailored treatments and holistic care. These findings pave the way for future research on psychosocial factors.

DOI: 10.5281/zenodo.10962592

Background: To study the clinical impact on the mother and fetus after Road Traffic Accidents with Head Injury and the effect on maternal and fetal outcomes of their management in Pregnant women. Materials: Out of 38 pregnant women included in this study, 13 (34.21%) were in the age group of 18 to 24, 11 (28.94%) were from the age group of 25 to 34 and 14 (36.84%) were from the age group of 35 to 44. The mean age was 25.60±2.15 years. 08 (21.05%) were in gestational age of 20 to 24 weeks, 14 (36.84%) were in gestational age of 24 to 30 weeks, 10 (26.31%) were in gestational age of 31 to 35 weeks. Results: Among the 38 pregnant women with RTA head injuries, 09 (23.68%) had preterm labour, 07 (18.42%) had Premature rupture of membranes (PROM), 11 (28.94%) had Preterm PROM, 06 (15.78%) had placental abruption, 03 907.89%) developed chorioamnionitis/sepsis, 02 (05.26%) patients were admitted in High dependency unit. Overall adverse outcomes were 15 (39.47%), the remaining new born were normal. The successful delivery of new born in the adverse status of maternal head injuries was observed in 60.53% patients. Conclusions: Pregnant women admitted to Emergency department with head injuries following Road Traffic Accidents tend sustain more severe injuries than normal women. The emergency admissions are to assess and monitor the fetal status and the maternal obstetric complications. However good outcome was possible with timely intervention and assistance of RTA patients and deliver the new born.

DOI: 10.5281/zenodo.10962592

Introduction: Paediatric patients undergoing ostomies have a high prevalence of cutaneous complications but are frequently overlooked. Available literature regarding peristomal cutaneous complications in the paediatric age group is scanty. In addition, as far as we know, there is no Indian literature available on this important issue, and no comprehensive study has been conducted to categorise and compare the occurrence of different dermatological problems in these paediatric patients. Therefore, we have designed this study to obtain a comprehensive understanding of this prevalent yet understudied issue, which will aid in its efficient prevention, management, and management in the future. Objectives: To epidemiologically study different peristomal skin complications in the Paediatric population undergoing stoma procedure. Material and Methods: This study was conducted after approval from the Institutional review board and ethical committee. All paediatric patients undergoing stoma surgery in the Department of Paediatric Surgery of Maharaja Yeshwantrao Hospital, Indore were included in the study. Recruited patients were subject to detailed history taking that included socio-demographic details, age, birth weight, and maternal age during delivery, maturity (preterm/term/posterm), educational status, occupational status, income, number of siblings, type of house, an indication of surgery. Results: 97 neonates were recruited for the study with a male: female ratio of 2.6:1. The mean age of patients in the study was 2.05 days. Skin complications were present in 48.5% of patients. 55.7% of patients living in the rural locality had skin complications while only 29.6% of urban locality patients had them. Similarly, those subjects dwelling in ‘kaccha’ house (58.46%) had more skin complications than those dwelling in pakka house (28.12%). Main indication for a stoma formation was Anorectal malformation (93.8%). Conclusion: A higher proportion of skin complications were seen in patients with Ileostomy in which 4 out of 4 patients had skin complications when compared to patients with colostomy in which 43 out of 93 had skin complications.

DOI: 10.5281/zenodo.10962592

Salmonella is a common cause of fever, especially in pediatric age group. As most of the symptoms are non-specific, an evidence-based clinical diagnosis of enteric fever cannot be made. For confirmation of diagnosis, isolation of Salmonella species from blood, stool, urine, or other body fluids is required. Though bone marrow culture is the gold standard for diagnosis, blood culture remains the mainstay practically feasible method for diagnosis of enteric fever. The present case is a 5 year old child who presented primarily with fever, swelling over left knee and limps after a fall and was initially diagnosed clinically as transient synovitis. Subsequently Salmonella paratyphi A was isolated from blood culture during the second visit of the child to the hospital. The case highlights the importance of blood culture as a primary investigation in children with nonspecific presentation along with fever.

DOI: 10.5281/zenodo.10962592

Introduction: Carcinoma stomach is the 2^nd principal cause of cancer-related death and the 5^th prime cause of cancer. Emergency presentation of carcinoma stomach influences the survivance and remarkably affects the prognosis. A surgical procedure is the only curative option for localized disease. Methods: It was a prospective type of study. About 58 patients who were admitted with carcinoma stomach in King George Hospital, Andhra Medical College, Visakhapatnam were studied. This study was undertaken from April 2022 to October  2023. Out of these 58, 11 were presented with acute symptoms and 47 were presented with non-acute symptoms. Results: A total of 58 patients presented: 11 were presented to an emergency department and 47 were presented electively. Patients presented to the emergency department were grouped according to the presentation. The results showed as 6 showed with obstructions, 4 with haematemesis, and 1 with perforation. Conclusion: Patients presenting in the emergency department are usually linked with a late stage of the illness. The resources should be made towards a diagnosis of the disease in the early stage, increasing awareness of the patient. There is a remarkable effect on morbidity and mortality in patients presenting with late-stage illness. Emergency presentation is rare and remarkably affects prognosis. In the setting of elective presentation for staging workup endoscopy, Endoscopic ultrasound, PET CT, and Staging laparoscopy are to be done.

DOI: 10.5281/zenodo.10962592

Background: Hypertension is on the raise among school going children. Obesity, body mass index (BMI), waist circumference (WC), and waist-to-height ratio, play an important role in the development of insulin resistance, predicting children with high blood pressure (BP). Objectives: The aim is to study the relationship of WC and BMI with the BP among school-going adolescents. Methods: This cross-sectional study was conducted in the department of paediatrics; Central India comprised 800 school going children between 10 and 16 years of age. Anthropometric measurements weight, height, WC was done using standard methods, and BMI was calculated. Normal BP was defined as values < 90th percentile and levels above this range were considered elevated. Results: The incidence of pre-hypertension and hypertension was 9% and 4.3%, respectively. Nearly 18.2% were overweight and 7.1% were obese. About 4.1% of the children had increased WC. Systolic and diastolic BP was higher in obese and central adiposity children. Prediction of pre-hypertension and hypertension among children was found to be statistically significantly associated with the high WC and high BMI. Conclusion: Obesity indicators such as WC and BMI because of its ease of measurement can be used as a screening tool to identify children with high BP.

DOI: 10.5281/zenodo.10962592

Background:  Neonatal sepsis and neonatal hypoglycemia are risk factors for abnormal neuro-motor and cognitive development and has been associated with abnormalities on brain imaging and a spectrum of developmental delays. Objectives: Aim of this study to determine the impact of Neonatal sepsis and hypoglycemia on neonatal neuro-developmental outcomes in our tertiary care hospital. Methods: This was a cross sectional observational study enrolled neonates suspected of neonatal sepsis and hypoglycemia admitted in our hospital during the study period. The neonatal hypoglycemia was defined as blood glucose ≤45mg/dL. Growth and Neuro-developmental Outcomes was measured and depicted in terms of weight, length, head circumference, Cerebral Palsy (CP), Visual Impairment, Hearing Impairment, developmental delay, tone abnormalities and retinopathy of Prematurity. Results: Among hypoglycemia group 32 (64%) were boys whereas among control group 56% had boys. No significant difference of baseline variables of neonatal hypoglycemia and control group, except Apgar score at 1 min and Hypoglycemic episodes. Among maternal demographic data Gestational age were significantly differ between the hypoglycemia and non hypoglycemic group. Majority of the maternal and neonatal parameters such as gestational age, Maternal Diabetes, IUGR, hospital stay, Neonatal Hypoglycemia, birth weight, Birth length and neonatal OFC were significantly difference among sepsis and non-sepsis group. Comparing the outcomes between the two groups the outcome of abnormal neurological examination was significantly more in sepsis group than in control. Conclusion: Neonatal sepsis was significantly associated with the abnormal neuro developmental outcomes but neonatal hypoglycemia produced neuro-developmental delay but it was not statistically significantly associated.

DOI: 10.5281/zenodo.10962592

Background: Menstruation is an important part of women’s life. Menstrual hygiene is very important by using proper menstrual products and facilities to dispose used menstrual material. A menstrual cup is a small, funnel shaped, flexible, made of silicone, latex, or a thermoplastic isomer that is inserted into the vagina to collect blood during menstruation. It is the most hygienic effective menstrual product. It reduces the burden of sanitary waste and can be used which lasts up to 10 years. It is marketed as an eco-friendly and cost-saving menstrual care. Objective: To assess the awareness, knowledge, practices and acceptance regarding menstrual cup among females of reproductive age group in a rural setting. Methods: A prospective study was conducted among 1000 study subjects among females of reproductive age group in rural setting during September 2023.Data collected from the selected eligible participants by an interviewer administered study proforma. Results: Out of 1000 participants, who took part in the study, among them 600(60%) were between 21-25 years, 200(20%) between 26-35 years and 200(20%) between 36- 45years. Among them 432(43%) knew about menstrual cup, good knowledge 292(67%) were between 21-25years, 96(22%) between 26 -30years,32(7%) between 31-35 years,12(2%) between 36- 45years. Among the users (n=287), 102(35.54%) did not experience any significant side effects. Conclusion: Based on the above study, it was found that while most young women were aware of the menstrual cup, a significant proportion of them did not use it primarily due to sociocultural and personal factors and presence of numerous misconceptions about menstrual cup.

DOI: 10.5281/zenodo.10962592

Aim:  To assess the level of knowledge among undergraduate medical students at Madha Medical College & Research Institute regarding hospital warning signs and symbols, and emphasize its significance. Background:  Understanding the significance of hospital warning signs and symbols is pivotal for maintaining a secure healthcare environment. Awareness of these warning signs is crucial to prevent unintentional exposure to health risks. The research endeavours to offer insights that can inform policies, training protocols, and practical guidelines, fostering an environment where hospital warning symbols are not just present but comprehended and acted upon effectively. Methods: A comprehensive cross sectional research methodology was implemented. The study cohort comprised 230 undergraduate students of phase I and phase III part II of medical curriculum. The pre- and post-tests were conducted to assess the impact of educational efforts on the targeted knowledge domain. Results:  The study recorded a mean pre-test score of 7.87 for all participants, which showed a significant improvement in the posttest score, reaching 9.49 out of 10. These findings highlight the importance of on-going and targeted safety education throughout the academic journey of healthcare students. It also emphasizes the need for tailored and continuous efforts to ensure that healthcare professionals are well-informed and safety-conscious.

DOI: 10.5281/zenodo.10962592

Background & Aims: This study aims to scrutinize the hemodynamic perturbations induced by laryngoscopy and tracheal intubation, exploring the modulating effects of Dexmedetomidine and Lignocaine. Emphasis is placed on evaluating the efficacy of a reduced Dexmedetomidine dosage. Methods and Materials: This single-center study at Gauhati Medical College and Hospital enrolled 82 ASA I-II patients (18–60 years) undergoing elective surgery. Randomized into Group D (dexmedetomidine) or Group L (lignocaine), patients received anesthesia according to group-specific protocols. The study aimed to compare the effectiveness of intravenous Dexmedetomidine (0.5 microgram/kg) and intravenous Lignocaine (1.5 mg/kg) in attenuating hemodynamic responses during laryngoscopy and tracheal intubation. Results: Of the 120 screened patients, 82 were randomized (41 in each group) with comparable baseline measurements. Both groups exhibited significant changes in heart rate, systolic/diastolic blood pressure, and mean arterial pressure during laryngoscopy and intubation. Dexmedetomidine showed a lower maximum rise in heart rate (8.17%) than Lignocaine (17.49%), indicating its potential advantage. Dexmedetomidine also demonstrated a milder increase in systolic blood pressure. Both drugs were well-tolerated with no serious adverse effects. Sedation levels were statistically insignificant. Conclusion: Administering intravenous Dexmedetomidine (0.5 microgram/kg) proved more effective in mitigating hemodynamic pressor changes during laryngoscopy and tracheal intubation than intravenous Lignocaine (1.5 mg/kg). Dexmedetomidine achieved this without significant adverse effects, highlighting its potential as a preferable option in clinical practice. Both drugs demonstrated the ability to alleviate pressor changes, but Dexmedetomidine, at a lower dosage, offers a favorable balance of effectiveness and safety.

DOI: 10.5281/zenodo.10962592

Background: Movement disorders (MD) encompass a wide range of neurological conditions causing abnormal voluntary or involuntary movements, significantly affecting quality of life. These disorders, including Parkinson’s disease, tremors, dystonia, and chorea, may escalate to emergencies requiring urgent care, especially in settings with limited resources and specialized care, such as in India. Methods: A prospective observational study titled “Spectrum of Movement Disorder Emergencies in a Tertiary Care Center in India” was conducted at Nalanda Medical College and Hospital, Patna, between 2021 and 2023. The study aimed to investigate the frequency, types, management, and outcomes of MD emergencies in a cohort of 60 patients using a systematic approach to data collection and analysis. Variables studied included demographic details, types of MD, emergency treatments, and patient outcomes, analyzed using descriptive statistics, Pearson’s correlation, and multiple regression analysis. Results: The study revealed a slight male predominance (56.7%) within a broad age range of 22 to 78 years, with an average disease duration of 6.5 years, reflecting the chronic progression of these disorders. Diverse MD emergencies were observed, including Parkinson’s disease exacerbations (28%), acute dystonic reactions (25%), and drug-induced disorders (18%). Treatment outcomes were predominantly positive, with a majority (66.7%) showing substantial improvement. A significant correlation (r = 0.36, p < 0.05) was found between the disease duration and the severity of the emergency presentation. Conclusion: MD emergencies present a diverse and complex challenge in tertiary care settings, with a spectrum of conditions requiring varied management strategies. Early and sustained management of MDs may mitigate the severity of emergencies, underscoring the need for specialized pathways and continuous management strategies. Recommendation: Healthcare systems, particularly in resource-limited settings, should enhance their preparedness for MD emergencies through specialized training, development of care pathways, and promotion of early management strategies.

DOI: 10.5281/zenodo.10962592

Background: T2DM leads to serious complications like metabolic and renal issues. Exploring the effect of diabetes duration on health markers is vital for better management and outcomes. Methods: The study examined 200 T2DM adults, analyzing the relationship between diabetes duration and levels of fasting blood glucose, serum urea, and creatinine, adjusting for age and sex. Results: There was a noticeable link between the duration of diabetes and greater amounts of fasting blood glucose, serum urea, and creatinine. This suggests a meaningful connection, even when considering other factors that could influence the results. Conclusion: The results highlight a deterioration in metabolic control and kidney function over time in T2DM patients. Recommendation: Early and continuous management of T2DM is crucial for controlling blood glucose and monitoring renal function to prevent severe complications.

DOI: 10.5281/zenodo.10962592

Background: Duodenal perforation, a potentially life-threatening condition marked by a hole in the duodenum, demands prompt surgical intervention. This study evaluates the outcomes of surgical management for duodenal perforation at Sheikh Bhikhari Medical College, Hazaribagh, focusing on the success rates and complications of open procedure surgery. Methods: In this retrospective cross-sectional study, 85 patients who underwent open surgical repair for duodenal perforation between January 2020 and December 2023 were analyzed. Data on demographics, cause and size of perforation, surgical outcomes, and post-operative recovery were collected. Statistical analysis was conducted to identify factors influencing the success and complications of the surgeries. Results: The majority of perforations were due to peptic ulcers (70.6%), with a surgical success rate of 92.9%. Post-operative complications occurred in 7.1% of the patients, with wound infection being the most common. The average hospital stay was 11 days, with longer stays associated with complications. Peptic ulcer-induced perforations had better surgical outcomes, and comorbidities significantly increased the risk of complications. Conclusion: Surgical management of duodenal perforation at the studied center had a high success rate, with the majority of complications being manageable. Peptic ulcer-related perforations responded particularly well to surgical treatment. Recommendation: Enhanced pre-operative assessment, especially in patients with comorbid conditions, and focused post-operative care are crucial for improving outcomes and reducing the duration of hospital stay in duodenal perforation cases.

DOI: 10.5281/zenodo.10962592

Background: The management of blunt trauma to abdominal solid organs in regions like Jharkhand, India, is critical, where healthcare challenges are prevalent. The trend towards non-operative management (NOM) is gaining prominence, supported by advancements in diagnostic imaging, patient selection criteria, and intensive care. Methods: This retrospective observational study at the Rajendra Institute of Medical Sciences, Ranchi, analyzed 75 patients with blunt abdominal trauma from January 2020 to December 2023. Patients were selected based on the presence of solid organ injury confirmed by imaging and managed non-operatively. Data on demographics, injury type and severity, management rationale, hospital stay, complications, and outcomes were collected and analyzed using statistical methods to evaluate NOM effectiveness. Results: Of the patients, 64% were male, with road traffic accidents being the most common injury cause. The liver was the most injured organ, and injuries were mostly Grade II and III. Non-operative management was successful in 90.7% of cases, with failure in 9.3% requiring surgery. Higher-grade injuries were associated with longer hospital stays and more complications. Conclusion: NOM for blunt abdominal trauma was highly successful, with injury severity predicting hospital stay length and complication rates. These findings endorse NOM as a viable treatment in resource-limited settings. Recommendation: Further research should explore long-term outcomes of NOM and develop specific guidelines to enhance patient selection and care protocols in similar healthcare environments.

DOI: 10.5281/zenodo.10962592

Background: Acute pancreatitis is a significant health concern characterized by sudden inflammation of the pancreas, with varied etiology and clinical outcomes. This study assesses the causes, symptoms, and consequences of acute pancreatitis at a tertiary care center in Ranchi, India, highlighting the influence of local factors like alcohol consumption on the disease’s prevalence and severity. Methods: A retrospective observational study was conducted at the Department of General Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi, involving 90 patients with acute pancreatitis from 2020 to 2023. Data on demographics, etiology, clinical presentation, treatment modalities, and outcomes were collected and analyzed. Statistical methods, including chi-square and logistic regression, were used to identify factors associated with disease severity and outcomes. Results:  Alcohol consumption emerged as the leading cause of acute pancreatitis (60%), followed by gallstones (22.2%) and idiopathic factors (11.1%). The condition predominantly presented with severe abdominal pain, nausea, and vomiting. A total of 55.6% had mild pancreatitis, while 16.6% had severe cases. Conservative management was effective in 70% of cases, whereas 30% required surgical or endoscopic interventions. The overall recovery rate was 88.9%, with a mortality rate of 11.1%. Severe cases were significantly associated with alcohol abuse and longer hospital stays. Conclusion: Acute pancreatitis in this region is notably linked to alcohol consumption, with a significant impact on the disease’s severity and patient outcomes. The high recovery rate indicates effective management strategies, yet the notable mortality and complication rates underscore the need for improved public health interventions targeting alcohol-related health issues. Recommendation: Public health efforts should focus on addressing alcohol abuse to reduce the incidence of acute pancreatitis. Early diagnosis and tailored management strategies are crucial for improving patient outcomes in acute pancreatitis.

DOI: 10.5281/zenodo.10962592

This study assesses the drug use patterns among orthopedic patients in Dr. D.Y. Patil Medical College, Navi Mumbai, focusing on the number of drugs per encounter, the ratio of injectable to oral drugs, and the utilization of anticoagulants, analgesics, and antibiotics. A cohort of 100 patients was analyzed over six months, revealing a median of 4.5 drugs prescribed per patient encounter, with a significant reliance on analgesics (80%) and antibiotics (70%), and a judicious use of anticoagulants (30%). The study found a balanced use of injectable (2 per prescription) versus oral drugs (3 per prescription), indicating a comprehensive approach to pharmacotherapy in orthopedic care. The prevalent use of analgesics and antibiotics underscores the focus on pain management and infection prevention, respectively, although it also highlights the need for cautious prescribing to mitigate risks associated with opioid use and antibiotic resistance. The inclusion of anticoagulants in post-operative care protocols reflects an evidence-based approach to preventing thromboembolic events, critical in orthopedic surgery outcomes. Patient outcome measures indicated an average hospital stay of 5 days, with a complication rate of 10% and a readmission rate of 5%, suggesting the effectiveness of the current pharmacotherapy strategies while also pointing towards areas for potential improvement. The findings emphasize the importance of evidence-based prescribing, patient education, and ongoing monitoring to enhance patient safety and outcomes in orthopedic care.

DOI: 10.5281/zenodo.10962592

Background: The hippocampus plays a pivotal role in memory formation and spatial navigation, its structure and function subject to modulation by various factors, including neuroplasticity. Despite its therapeutic efficacy in severe depression, the specific effects of Electroconvulsive Shock (ECS) therapy on hippocampal neuroplasticity remain poorly understood. Materials and Methods: This study, conducted at St. John’s Medical College, Bangalore, aimed to evaluate the impact of ECS on hippocampal neuroplasticity. Inbred male Wistar rats underwent ECS treatment for six consecutive days, followed by Golgi staining of hippocampal tissue. Morphometric analysis was conducted to assess dendritic node counts. Results: The study revealed significant differences in dendritic node counts between the ECS-treated and control groups (mean difference: 9.24 nodes, p ≤ 0.002), indicating ECS’s potential to modulate hippocampal neuroplasticity. Conclusion: ECS therapy may serve as a modulator of hippocampal neuroplasticity, shedding light on its therapeutic mechanisms in neurological disorders. These findings contribute to our understanding of hippocampal function and dysfunction, informing future treatment strategies.

DOI: 10.5281/zenodo.10962592

Background and Aims: Laparoscopic surgery is a minimally invasive surgery which is getting popularity nowadays for its varied benefits. Pneumoperitoneum being an integral part of laparoscopic surgery, alters the respiratory and cardiovascular  mechanics. Positive End Expiratory Pressure (PEEP) after pneumoperitoneum might counteract those adverse physiological changes. The aim of the study was to assess Lung compliance, airway pressures and hemodynamics after pneumoperitoneum induction and after giving PEEP. Material and Methods: This is a prospective observational study done on 121 patients undergoing laparoscopic abdominal surgery. Parameters observed were Lung Compliance (LC), Peak and Plateau airway pressure, Heart Rate (HR) and Mean Arterial Pressure (MAP) after intubation (int), 5 minutes after pneumoperitoneum induction (pnm) and 5 minutes after giving PEEP of 5 cm H₂O. Statistical analysis plan was done and p-value<0.05 was takes as significant. Results: Mean value of LC_pnm is decreased than LC_int(LC_int– 35.19 ± 5.423 ml/cmH₂O vsLC_pnm– 27.05 ± 5.234 ml/cmH₂O) and incresed significantly after application of PEEP (LC_pnm– 27.05 ± 5.234 ml/cmH₂O vs LC_PEEP-30.75 ± 5.514 ml/cmH₂O, p< 0.0001). Mean Peak airway pressure_int is 18.18± 2.443 cm H₂O, mean Peak airway pressure_pnm is 18.826± 2.654 cm H₂O (Increased) and mean Peak airway pressure_PEEP is 21.80± 2.845 cm H₂O (Increased). Likewise mean Plateau airway pressure_int is 11.07± 2.549 cm H₂O, mean plateau airway pressure_pnm is 11.71± 2.51 cm H₂O (Increased) and mean plateau_PEEP is 15.107± 2.738 cm H₂O (Increased). Conclusions: PEEP applied after pneumoperitoneum improves LC without any adverse effect on airway pressure.

DOI: 10.5281/zenodo.10962592

Introduction: In one in six people, allergic rhinitis (AR) causes nasal congestion and sneezing. Asthma is one of the diseases that is associated with it. Globally increased AR prevalence affects children’s academic performance and well-being. To lessen its negative impact on health and school attendance, effective management is essential. Effective treatments include immunotherapy and sublingual steroids. Reducing the negative effects of AR on children’s lives requires prompt action Aim and Objectives: The objective is to evaluate the impact of allergic rhinitis on school-age children by conducting a study based on surveys. Method: A cross-sectional study was conducted during the period of one year with students from rural high school children in Jaipur. Allergy rhinitis (AR) prevalence and quality of life were compared to healthy peers. We cluster-sampled 341 children out of 3000. Participant demographics, AR symptoms (as measured by the SFAR and ARYA scales), and SF-36 quality-of-life measures were all included in the study. Participants underwent basic sampling and included both AR and healthy peers. Result: Children with allergic rhinitis (AR) demonstrated distinct characteristics compared to those without AR. AR children were older (13.65 vs. 12.05 years) and had a higher prevalence of asthma (10.00% vs. 12.29%) and eczema (2.50% vs. 2.99%). AR children also exhibited significantly higher IgE levels (102.58 vs. 5.6 ng/mL) and eosinophil counts (14.2 vs. 0.5), indicating an active allergic response. While quality of life scores varied, AR did not significantly impact mental health domains, suggesting a multifaceted influence of AR on children’s health. These findings underscore the clinical and immunological disparities associated with AR, highlighting its significance in pediatric health. Conclusion: This study concluded that the prevalence of AR in the sample is 11.73% and significantly affects quality of life (QoL) and the incidence of related symptoms and disorders in high school children.

DOI: 10.5281/zenodo.10962592

Introduction: The following study has emphasized that MRI is the best modality to evaluate anal fistula preoperatively. It helps in diagnosis, characterization and monitoring disease. Furthermore, MRI accurately depicts fistulous tracts, associated abscesses, and their relation both sphincters. It helps in proper surgical planning and lowers recurrence rates. Poorer patient outcomes are associated with Higher MRI grades. T2-weighted and post-gadolinium T1-weighted imaging is also helpful in assessment of anal fissures. Aims and Objectives: The aim of this study is to analyze and determine the best management for anorectal fistulas with the help of magnetic resonance imaging (MRI). Methods: This retrospective study was done at university medical center for determining the accuracy of MRI in identifying fistula-in-ano, from January 2021–January 2022 in surgical patients. Ethics committee approval with written informed permission was obtained for the study. MRI scans were assessed by radiologist, with surgical records as a reference. MRI data were compared to surgical analysis to assess the MRI’s accuracy in recognizing primary and secondary tracts, opening location and associated abscesses. Results: Table 1 shows fistula type with’ external opening-anal margin distances. Table 2 analysis of Parks-classified main tract classifications from MRI and surgery. Table 3 MRI and surgery agreeness on secondary tract locations analyze Table 4 compares T2W TSE with post-contrast FS T1W TSE fistula characterization. T2W TSE performed well for internal openings and secondary tracts. Post-contrast FS T1W TSE was used to diagnose abscesses wall with lower specificity but better sensitivity. Conclusion: This study has concludes that MRI is statistically efficient in mapping and characterization of fistula-in-ano and can contribute significantly in surgical prognosis.

DOI: 10.5281/zenodo.10962592

Introduction: Lifestyle, heredity, and environmental variables all have a role in the development of obesity, a complicated disorder. The rising prevalence of childhood obesity in India is associated with serious health problems such as diabetes and cardiovascular disease. The problem is worsened by urbanisation and changes in diet, whereas rural areas already encounter nutritional difficulties. These complex concerns require holistic solutions and better healthcare. Aims and Objectives: To conduct a study to determine the frequency and causes of obesity in children between the ages of 5 and 18 in rural ,Jaipur to gather information for the development of specific interventions. Method: A cross-sectional study was conducted during the period of one  year in rural area, examined 334 obese 5-18-year-olds. Mothers filled out surveys that collected information like anthropometrics and sociodemographics. Regular procedures for determining body mass index (BMI) involved measuring both height and weight. Achieving a healthy weight was determined by referring to CDC growth charts. National Family Health Survey-3 combined overweight and obese children due to diet similarities. Result: This research investigates the prevalence of childhood obesity in Jaipur, India, focusing on a variety of characteristics, including socioeconomic level, family history, dietary patterns, and lifestyle habits. Findings showed that income, parental occupation, food choices, and exercise habits were significantly correlated with the prevalence of obesity. These findings highlight the significance of tackling many factors in order to successfully address the issue of childhood obesity. Conclusion: The study has concluded that the prevalence of obesity in rural areas of Jaipur was found to be 7.18% and the factors like genetic predispositions, socioeconomic level, nutrition, and lifestyle are the primary factors affecting obesity among children.

DOI: 10.5281/zenodo.10962592

Introduction: Hypoglycemia amongst neonates is the most commonly encountered metabolic problem and is known to be due to failure of metabolic adaptation to the postnatal environment. Premature, small for gestational age, neonates born to mother with insulin dependent diabetes mellitus or gestational diabetes, and neonates with hyperinsulinaemia are at high risk for developing neonatal hypoglycemia.[9,10] The rate of hypoglycemia amongst neonates born to diabetic mothers ranges between 8–30% whereas that amongst neonates of non-diabetic mother is much lower i.e. approximately 3%. Objectives: To determine incidence of hypoglycemia and factors associated with hypoglycemia in at risk neonates. Methodology: This study was conducted among sick newborn care unit, Department of Pediatrics, Gandhi Medical College and associated Kamla Nehru Hospital, Bhopal from 1st October 2018 to 31st March 2020. All the at risk neonates diagnosed as hypoglycemia (Blood glucose ≤45 mg/dl) in SNCU i.e. small for gestational age, low birth weight babies, large for gestational age and infant of diabetic mother were includes for this study. Neonates admitted in SNCU with Moderate to severe Respiratory distress, Perinatal asphyxia, Shock, Sepsis, Congenital heart diseases, Major congenital Malformation & Meconium aspiration syndrome were excluded from the study. Results: Majority of neonates in both the groups (96.7%) belonged to age range of less than or equal to 6 hours whereas only 3.3% neonates were aged more than 6 hours. Mean age of neonates with and without hypoglycaemia was 3.28±1.55 and 3.04±1.52 hours respectively. In present study, out of 50 hypoglycaemic neonates, 40% were males whereas 60% were females. Similarly out of 70 neonates with normal RBS levels, 44.3% were males whereas 55.7% were females. About 76% neonates with hypoglycaemia were inborn whereas 24% were outborn. Similarly, about 82.9% neonates with normal glycaemic status were inborn whereas only 17.1% neonates were outborn. Conclusion: Our study conclude that Pre-eclampsia was significantly associated with neonatal hypoglycaemia. Common risk factors among neonates with hypoglycaemia were low birth weight, NNH, and IUGR but no statistically significant association between these factors and hypoglycaemia was observed. Hypoglycaemia significantly affect neurodevelopmental outcome of neonates in long term.

DOI: 10.5281/zenodo.10962592

Background: Prevalence of NAFLD in patient with T2DM is around 56% across the world and highest in Europe 68%. These patients are having higher risk of death but not related to the liver-related death issues. However, these patients are associated with advance liver fibrosis that improves the mortality the lead to liver-related deaths. Moreover, NAFLD in patient of T2DM is also increasing the risk related to cardiovascular diseases and chronic kidney among the general population which starts from the childhood. Apart from this, NAFLD is kind of metabolic syndrome that increase the problem related to fatty liver. Aim: The current study aims to determine factors associated with non-alcoholic fatty liver disease and its prevalence in type-2 diabetes mellitus patients. Method: It was a cross sectional study that has been conducted among the adult patients aged between 25 to 50 years at C.R. Gardi Hospital and R.D. Gardi Medical College, Ujjain between April 2022 and March 2023. Patient with history of liver disease, pregnant women, patient with alcohol intake were included in the study. Patients on amiodarrone, anti-epileptic drugs and methotrexate were excluded from the study. Moreover, non-diabetic patient were selected randomly who were willingly looking to take part in the study. To collect the data about the disease and risk factors, a questionnaire was prepared involving information about socio-demographic characteristics. The laboratory data was collected from the medical records. Patients were asked to fast for at least eight hours before having venous blood samples taken in the morning. Results: According to analysis total 400 diabetic and 80 non-diabetes patients were involved in the study, and fatty liver was found among 320 (80%) diabetic and 40 (50%) non-diabetic patients. The current study indicated that 80.4% of people had NAFLD. There was a 25.5% and 15.2% prevalence of increased ALT and AST, respectively. Elevated ALT and AST were more common than 5.4% and 10.4%, respectively, in a research that was carried out at the same centre around ten years ago. According to our research, NAFLD has a favorable correlation with both high TG levels (OR: 1.91, 95%CI: 1.21–3.02, P = 0.006) and low HDL levels (OR: 2.73, 95%CI: 1.57–4.71, p = 0.000). Generally, hypertriglyceridemia and an elevated TG/HDL ratio contribute to the development of NAFLD by causing fat to build up in the liver parenchyma. Conclusion: From the study analysis, it has been considered that NAFLD is affecting the patient of T2DM and issues related to obesity, improvement in waist circumference, low HDL, elevated TG and sulfonylureas are associated with the development of NAFLD. The changes in the lifestyle and weight reduction are recommended for prevention from NAFLD.

DOI: 10.5281/zenodo.10962592

Background: Total Joint Arthroplasty (TJA) significantly improves the quality of life for patients with joint diseases but is associated with risks, including lower urinary tract infections (UTIs) and deep sepsis. These complications can affect patient recovery and increase healthcare costs, highlighting the need for optimized perioperative management. Methods: This retrospective cohort study analyzed 300 patients who underwent TJA at Dr. Bijoy Prasad Nursing Home over six months. The study aimed to assess the incidence of lower UTIs and deep sepsis, explore associated risk factors, and evaluate their impact on outcomes. Results: Of the patients studied, 16.67% developed postoperative complications (10% lower UTIs, 6.67% deep sepsis). Factors such as advanced age, diabetes, and previous surgeries were significant predictors of these complications. Those with complications had longer hospital stays and more recovery issues. Conclusion: The incidence of lower UTIs and deep sepsis post-TJA highlights the importance of targeted perioperative management, especially for at-risk patients, to improve surgical outcomes. Recommendation: Implementing risk-specific perioperative protocols can potentially reduce the occurrence of these complications, enhancing patient recovery and surgical efficiency.

DOI: 10.5281/zenodo.10962592

Background: A typical orthopedic treatment for severe knee arthritis or injury is total knee arthroplasty (TKA). Due to their deteriorated health and immunosuppressive medication, renal transplant recipients and end-stage renal disease (ESRD) patients present distinct hurdles. Optimizing patient care requires understanding how the renal state affects TKA results. Methods: The retrospective study evaluated TKA outcomes in kidney transplantation and dialysis-dependent ESRD patients. The 100 adult patients (50 per group) were carefully matched by age, gender, and comorbidities to reduce bias. Medical records, perioperative treatment, standardized complications, functional outcomes, and patient satisfaction surveys were reviewed to obtain data. Results: Patients with renal transplants experienced significantly fewer perioperative complications (12% vs. 24%, p=0.04) and shorter hospital stays (5 vs. 7 days, p=0.03) compared to those with ESRD. Functional outcomes, measured by the Knee Society Score, showed greater improvement in the renal transplant group (30-point increase) than in the ESRD group (20-point increase), with a statistically significant difference (p=0.01). Moreover, renal transplant recipients reported higher satisfaction rates (88% vs. 68%, p=0.02) postoperatively. Conclusion: Renal status independently predicted perioperative complications, hospital stay, functional outcomes, and patient satisfaction following TKA. Patients with renal transplants exhibited superior outcomes and greater satisfaction compared to those with ESRD. These findings underscore the importance of tailored management strategies for patients with renal conditions undergoing TKA. Recommendation: Multidisciplinary care, including preoperative optimization and vigilant postoperative monitoring, is crucial for improving TKA outcomes in patients with renal diseases. Clinicians should consider renal status as a key factor in decision-making and prioritize renal transplant as a potential protective factor in TKA candidates with chronic kidney disease.

DOI: 10.5281/zenodo.10962592

Background: Acute kidney injury (AKI) is a notable risk in patients undergoing total joint arthroplasty (TJA), especially with postoperative dual NSAID use. This study assesses AKI incidence and severity in patients receiving NSAIDs after outpatient TJA. Methods: A six-month prospective cohort study at Dr. Bijoy Prasad Nursing Home included 150 patients, divided into an NSAID group (n=75) and a control group (n=75). AKI detection followed KDIGO criteria, using creatinine level changes. Analysis utilized chi-square, t-tests, and logistic regression. Results: The NSAID group showed a higher AKI incidence (24%) versus the control group (9.3%), with significant lengthier hospital stays (4.2 days vs. 3.7 days, p=0.048). No difference in long-term outcomes was noted, though NSAID users reported slightly lower satisfaction. Conclusion and Recommendation: Dual NSAID use post-TJA significantly raises AKI risk and hospital stay length without affecting long-term recovery. Careful NSAID use and strict renal monitoring are advised to reduce AKI risk in outpatient TJA settings.

DOI: 10.5281/zenodo.10962592

Background: Functional Endoscopic Sinus Surgery (FESS) has revolutionized the treatment of chronic rhinosinusitis (CRS), offering a minimally invasive approach to sinus diseases. However, the success of FESS depends significantly on postoperative medical management, which plays a crucial role in optimizing patient outcomes and enhancing quality of life. Methods: A retrospective cohort study was conducted at RIMS (Rajendra Institute of Medical Sciences), involving 100 patients who underwent FESS for CRS. Patients received various postoperative treatments, including pharmacotherapy and nasal irrigation. Clinical outcomes were assessed through symptom improvement, objective measures, and complication rates. Results: Following FESS, patients experienced significant improvement in sinonasal symptoms and a reduction in sinus inflammation. Pharmacotherapy, nasal irrigation, and adjunctive treatments were commonly prescribed postoperatively. While no significant differences were observed among treatment groups, patients adhering strictly to nasal irrigation and corticosteroid therapy showed promising trends toward better outcomes. Complications following FESS were rare, with no serious adverse events reported. Conclusion: The study indicates favorable outcomes following FESS, emphasizing the importance of personalized postoperative medical management. Although no significant differences were found among treatment groups, strict adherence to certain treatments may offer additional benefits. Long-term follow-up is recommended to refine post-FESS management protocols further and optimize patient care. Recommendations: Clinicians should consider personalized postoperative medical management based on patient characteristics and preferences. Further research is needed to explore the long-term effects of different treatment strategies and refine post-FESS care protocols accordingly.

DOI: 10.5281/zenodo.10962592

Background: Venous ulcers, a manifestation of chronic venous insufficiency, significantly impact patients’ quality of life and pose a burden on healthcare systems. Pentoxifylline, a methylxanthine derivative known for its vasodilatory action, has shown promise in improving microcirculation, reducing inflammation, and enhancing tissue oxygenation, which are critical in the healing process of venous ulcers. The purpose of this research is to assess pentoxifylline’s safety and effectiveness in the management of venous ulcers, with an emphasis on healing rates, ulcer size reduction, pain alleviation, and quality of life enhancement. Methods: A total of sixty individuals with confirmed cases of venous ulcers were enrolled and randomly allotted to one of two groups: the pentoxifylline-treated therapy group or the routine wound care group. Following a baseline, data on healing rates, ulcer size, pain scores, and quality of life were gathered every week. Statistical analysis was accomplished with a significance level of p < 0.05. Results: There were sixty participants in the trial, equally divided between the treatment and control groups. In comparison to the control group, the pentoxifylline group demonstrated a considerably higher healing rate (80% vs. 50%, p < 0.05) and a bigger reduction in ulcer size (65% vs. 45%, p < 0.01). The pentoxifylline group also experienced a significant improvement in pain scores and quality of life indicators. The fact that no significant side effects were recorded suggests the safety of the medication. Conclusion: Pentoxifylline significantly enhances the healing of venous ulcers, reduces pain, and improves the quality of life in patients, with minimal side effects. Its use as an adjunct to standard wound care offers a promising approach to managing this challenging condition. Recommendations: Future research should focus on long-term outcomes of pentoxifylline treatment and its integration into comprehensive venous ulcer management protocols. Larger, multicentric trials are recommended to validate these findings and explore the full potential of pentoxifylline in venous ulcer care.

DOI: 10.5281/zenodo.10962592

Background: Laparoscopic cholecystectomy (LC) is the standard procedure for gallbladder removal, typically involving umbilical or epigastric port sites. The prevalence of post-operative port site infections (PSIs) varies and may be influenced by the choice of port site, potentially affecting patient recovery and healthcare costs. The study aims to evaluate the incidence of PSIs and other postoperative outcomes in patients undergoing LC through either umbilical or epigastric ports. Methods: A total of 80 patients with benign gallbladder disease who were scheduled for elective LC were included. Random assignment was used to determine which port—the umbilical or the epigastric—would be used for LC. The primary outcome was PSIs at both port locations on post-operative days 10 and 30. Gallbladder retrieval difficulty, surgical discomfort, and port site scarring at 6 months were secondary outcomes. Data were analyzed with significance set at p<0.05. Results: There were 80 individuals in the trial; 40 underwent LC through an umbilical port and 40 using an epigastric port. By postoperative day 30, the incidence of PSIs was 5% in the epigastric group and 10% in the umbilical group; there was no statistically significant variance between the two (p>0.05). The two groups did not significantly differ in terms of postoperative pain levels, satisfaction with port site scarring, or gallbladder retrieval difficulty scores. Conclusion: The choice between umbilical and epigastric ports for LC does not significantly affect the incidence of PSIs, gallbladder retrieval difficulty, postoperative pain, or satisfaction with port site scarring. Both port sites are viable options for LC, with comparable postoperative outcomes. Recommendations: Surgeons can choose the port site for LC based on personal preference, patient anatomy, and specific clinical indications without concern for significant differences in postoperative outcomes. Future research should focus on identifying other factors that may influence the risk of PSIs and optimizing surgical techniques to further improve patient care.

DOI: 10.5281/zenodo.10962592

Background: In the era of digital revolution and transformation, Medical Education has undergone an astonishing shift with the introduction of e-Learning, also known as Electronic Learning. Amid challenging situation like the COVID-19 pandemic, e-Learning has played a crucial role in ensuring the continuity of Medical Education without being hindered by prolonged lockdowns and closures. Aim and Objective: The aim of the study was to assess the effectiveness of e-Learning during COVID-19 pandemic among under and post graduate medical students, focusing mainly on their perception. Materials and Methods: A cross-sectional study was conducted utilizing a self-administered, semi structured questionnaire that went standardization by testing in 50 medical students. Upon obtaining Ethical Clearance from the Institutional Ethical Committee, the questionnaire was formatted into Google Forms and disseminated among medical students via social media channels. The study was carried out between 1st November 2020 to 31st January 2021. Responses from the participants were recorded for analysis. A total of 504 students took part in the study. The study evaluated various aspects including the demographic profile of the participant, their approachability to e-Learning Teaching Methods, perception and effectiveness of e-Learning, satisfaction towards e-Learning sessions, and their rating and preference of e-Learning methods. This comprehensive assessment aimed to provide insights into the impact and efficacy of e-Learning in medical education during unprecedented times. Results: The study, involving 504 students, revealed that the majority had the necessary equipment and Information & Technology skills for e-Learning participation. However, about half of the students encountered network issues during e-Learning sessions, posing a significant challenge. From the students’ perspective, 95 respondents (18.8%) found e-Learning effective when compared to traditional classroom learning, while 151 (30.0%) rated their e-Learning experience during COVID-19 pandemic at >75% and 173 (34.0%) rated it below 50%. Despite these ratings, a significant majority (79.6%) preferred traditional classroom learning over e-Learning. Nonetheless, 160 students (31.7%) advocated for integrating e-Learning with traditional lectures, suggesting a potential hybrid approach. Substantial preference for e-Learning was noted among undergraduate students compared to postgraduate students (Odds Ratio 2.74, 95% Confidence Interval 1.75 to 4.30, p = <0.0001). Conclusion: These findings underscore the complexity of student preferences and highlight the need for tailored educational strategies to meet diverse learning needs effectively.

DOI: 10.5281/zenodo.10962592

Background:  The appropriate course of action for displaced scapular fractures has been a subject of debate and inconsistency among surgeons. The complexity of the anatomy, approaches, and fracture patterns has deterred surgical intervention for these relatively rare fractures. It remains uncertain whether outcomes such as return to work, pain levels, or complications vary between nonoperative and operative treatment approaches for these fractures. Thus, we aimed to compare the rates of union, range of motion, ability to return to work, pain levels, and occurrence of complications between patients who underwent operative versus nonoperative treatment for scapular body and neck fractures. Patients and Methods: We examined a consecutive series of 36 patients presenting with scapular fractures at a tertiary referral center over a two-year period (2021 to 2023) in an unblinded study. Of these patients, 18 received open reduction internal fixation, matched by age, occupation, and gender with 18 patients treated non-operatively. The distribution of AO/OTA fracture types was similar between the two groups. On average, the operative group exhibited greater displacement, shortening, and angulation compared to the nonoperative group. Patients were followed until healing or discharge from care (average follow-up duration, 1.5 years; range, 14–32 months), with assessments including complications, return to work status, and radiographic healing. Results: All fractures achieved union, and no significant differences were observed in return-to-work rates, pain levels, or incidence of complications between the two treatment groups. Conclusions: Our findings indicate that operative treatment of displaced scapular fractures yields comparable outcomes in terms of healing, return to work, pain management, and complication rates when compared to nonoperative treatment. We recommend against surgical intervention for scapular neck or body fractures with displacement less than 20 mm.

DOI: 10.5281/zenodo.10962592

Background: Surgical resection of the primary breast tumor with axillary dissection is one of the main modalities of breast cancer treatment. The most common modality for anesthesia is general anesthesia with or without regional blocks. Regional blocks have been considered as one of the modalities for effective perioperative pain control. The addition of ketamine to epidural lidocaine or bupivacaine increases the duration of regional anesthesia and postoperative analgesia. Our study was meant to evaluate that adding ketamine as an adjuvant to bupivacaine, administered as a single injection in ultrasound guided Pectoral nerve block would enhance the quality of post-operative analgesia after modified radical mastectomy Methodology: This is a prospective observational study, conducted in Government Dharmapuri medical college hospital, Dharmapuri after approval of the institutional ethical committee. Patients were given ultrasound guided, modified pecs block were included in control group. Patients were given ultrasound guided, modified pecs block with ketamine (1 mg/kg) were included in test group that is ketamine group. Results: The mean duration of surgery in group 1 was 120 min +/- 40.58 min and in group 2 was 107 min+/- 31.64 min with a p value of 0.060, statistically not significant. Both the groups were comparable in the study. VAS was compared between 2 groups with chi square test at each hour at 8^th hr-p value of 0.511, which is statistically not significant at 24 hrs p value of 0.605, statistically not significant mean value of vas score was lower in control group than ketamine group but statistically not significant. The mean time of request for rescue analgesic in group 1(Control group) is 620min(10hr 30 min)+/- 116.9 minutes and in group 2 (ketamine group) is 1091.5 min(18 hrs)+/-106.91 min ,with a p value of <0.001. There is statistical significance between 2 groups. Conclusion: In conclusion, the addition of ketamine to modified Pecs block prolonged the time to first request of analgesia and reduced total opioid consumption without serious side effects in patients undergoing modified radical mastectomy.

DOI: 10.5281/zenodo.10962592

Introduction: Platelet-rich plasma (PRP) has been widely studied as a potential nonsurgical treatment for knee osteoarthritis. The current study was done to assess the effectiveness of PRP injections in terms of pain reduction and functional outcomes. Materials and Methods: In this prospective randomized clinical study, 50 patients with early osteoarthritis knees who met the inclusion criteria received two intra-articular pure PRP injections. Follow-up assessments were performed at 6 weeks, 3 months, 6 months, and 1 year for pain reduction measured on the Visual Analog Scale (VAS) and functional improvement assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. The pre and post injection WOMAC and VAS scores were compared. A p value < 0.05 was considered significant. Results: Two intra-articular injections of PRP were administered to 50 patients. Female patients were 27(54%) and male 23(46%). Majority (60.%,n=30) of knees had grade II Osteoarthritis while 20(40%) knees had grade I Osteoarthritis. Each follow-up visit resulted in a significant improvement in pain reduction (VAS) and functional outcome (WOMAC), which maintained until the final follow-up appointment at one year. No complications were reported. Conclusion: Two intra-articular PRP injections in an early osteoarthritis knee resulted in a significant reduction in pain and improved functional results.

DOI: 10.5281/zenodo.10962592

Background: Laryngoscopy and endotracheal intubation cause an intense reflex which produces a significant increase in heart rate, blood pressure, due to an increased sympathoadrenalic pressor response. Various agents are being tried to combat the intubation response. The objective of the study is to compare the efficacy of dexmedetomidine which is a highly selective alpha-2 agonist with an ultrashort-acting beta blocker esmolol in attenuating the haemodynamic stress response secondary to laryngoscopy and endotracheal intubation. Methods: After obtaining an approval from Institutional Ethics Committee and after having informed and written consent from each patient, 60 adult patients scheduled for elective surgery under general anaesthesia were selected and provided general anaesthesia with endotracheal intubation for all patients. Patients were randomly allocated into two groups, Group Dexmedetomidine and Group Esmolol with 30 cases in each group. Group Dexmedetomidine received infusion of Dexmedetomidine 1 mg/kg diluted in 20 mL 0.9% normal saline (NS) over 10 minutes, and Group Esmolol received infusion of Esmolol 0.5 mg/kg diluted in 20 mL NS over 10 minutes. Patient’s heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) was recorded at baseline, after infusion of study drug, after induction of anaesthesia, immediately and 1, 3 and 5 minutes after intubation. Results: All the study parameters were collected and documented by a single anaesthesiologist in all cases. The percentage change of all haemodynamic parameters from baseline was similar in both the dexmedetomidine group and the esmolol group at all-time points of measurement. Hence, no statistically significant difference was observed at any time points after tracheal intubation. Conclusion: Both dexmedetomidine 1 mg/kg and Esmolol 0.5 mg/kg were equally effective in controlling the heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressures following laryngoscopy and intubation.

DOI: 10.5281/zenodo.10962592

Introduction: The anterior cruciate ligament tear is the most common severe ligamentous injury to the knee. Arthroscopic ACL reconstruction is indicated, with many graft possibilities including quadrupled semitendinosus and gracilis, doubled peroneus, quadriceps tendon, and bone patellar tendon-bone. So, the current study was conducted to evaluate the functional outcome of anterior cruciate ligament reconstruction with quadrupled semitendinosus autograft. Materials and Methods:  The present prospective study comprised 30 patients under the age of 55 years who were referred with ACL deficit to the orthopedic department of a Mallareddy Institute of Medical Sciences in Hyderabad between August 2021 and July 2022 and had arthroscopic ACL Reconstruction. They were examined utilizing the Lysholm and Gilquist knee grading system. Patients were followed up for a minimum of one year. Results: In the present study, out of 30 patients, 23(76.7%) were male and 7(23.3%) were female patients aged between 18 and 50 years were included in this study, with 24 (80%) being younger than 36 years. 19 patients (63%) had knee involvement on the right side, while 11 patients (37%) had knee involvement on the left side.. As per the Lysholm scoring system, 11 (36.7%) patients had an Excellent outcome; 15 (50%) had a Good outcome. complications were seen in only 6 patients. Conclusion: In conclusion, quadrupled semitendinosus graft arthroscopic ACL Reconstruction yields excellent functional outcomes with low morbidity.

DOI: 10.5281/zenodo.10962592

Introduction: Brachial Plexus block is a safe alternative to general anesthesia for upper limb surgery, used for reducing pre-operative pain. Techniques include classical blind techniques, nerve stimulators, ultrasound guidance, and supraclavicular block. Ultrasound guidance improves success rates and reduces complications. Additives like oploids, clonidine, dex-amethasone, and hyaluronidase increase block duration and post-operative pain management. Dexmedetomidine, an α2 adrenoreceptor agonist, has been used as an adjuvant to local anesthetics to prolong analgesia and improve block quality. Methodology: A study at C. U. Shah Medical College and Hospital involved 60 patients aged 20-60 with ASA grade I and II physical status, scheduled for upper limb surgeries. Discussion: The study compared the duration of analgesia in two groups after surgery. The combination group had shorter onset times for sensory and motor nerve blockade, longer durations, and lower VAS scores. The combination group had lower rates of adverse reactions. The study found no significant differences in age, sex distribution, body weight, ASA status, or surgery duration. Dexmedetomidine was found to be safe for use in small doses with local anesthetics. Conclusion: Ultrasound guidance improves success rate, reduces complications, and expedites sensory and motor block onset compared to Ropivacaine alone. Addition of Dexme-detomidine prolongs block duration and analgesia duration.

DOI: 10.5281/zenodo.10962592

Background: During the 20th century, in parallel with this decreasing maternal mortality, there has been an increase in the incidence of Caesarean section. Also, the rates of Caesarean section performed with no clear medical or obstetrical indication are rising dramatically. Despite the low maternal mortality associated with Caesarean section, the available studies indicate a crude risk ratio of approximately 10 for maternal mortality with Caesarean section compared with vaginal delivery. In 2011, a systematic review and critical appraisal of available classifications for caesarean concluded that women-based classifications in general and Robson’s 10-group classification in particular, would be in the best position to fulfil current international and local needs. The review recommended that efforts to develop an internationally applicable classification should be most appropriately placed in building upon this classification.  Dr Michel Robson proposes a system that classifies women into 10 groups based on their obstetric characteristics (parity, previous caesarean, gestational age, onset of labour, foetal presentation and number of foetuses) without needing the indication for caesarean. Method: This study was carried out in the department of obstetrics and gynaecology at PDU medical college and hospital Rajkot, Gujarat from September 2019 to March 2020. Result: The study was conducted on 1000 cases, the prevalence rate of Caesarean section in the study population of PDU medical college Rajkot was found to be 27.4% during our study period. All women with one or more previous caesareans (group V) had the maximum number of caesarean section 109 (39.78%), closely followed by nulliparous women with spontaneous onset of labour at >37 weeks (group I) 54 (19.70%) and nulliparous women more than 37 weeks who were induced (group IIA) 45(16.04%). Conclusion: All hospital and health authorities can use this standardized classification system as part of quality improvement initiative to monitor caesarean sections rates. This classification system identifies relevant areas of interventions and resources to reduce rates of Caesarean sections.

DOI: 10.5281/zenodo.10962592

Introduction: Poisoning is one of the common emergency seen in Emergency Medicine department (EMD), which affects world health. Raising public awareness, implementing preventative measures, and enacting legislative steps are all necessary to tackle this complexity. Rapid assessment, tailored therapy in EMD are essential for poisoning situations. Developing targeted interventions and mitigating poisoning effect on public health depends on our ability to understand poisoning patterns and outcomes. Aims and Objectives:  To study poisoning cases presented in the Emergency Medicine Department, including the type and manner of poisoning. Material and Methods: An observational study spanning 2 years (1^stJanuary 2022 to 31^stDecember 2023) was conducted in Emergency Medicine Department (EMD) of SKN Medical College & General Hospital, Pune. Data sourced from hospital records with approval. Poisoning diagnosed via medical history, exam, and laboratory tests. Analyzed details include poisoning mechanism, arrival time, consciousness, hospital stay, outcomes, and demographics. Inclusion criteria: Patients presented to EMD with complete records and poisoning diagnosis. Result: The study analyzed 143 cases of poisoning, with age and gender distributions highlighted in the socio-demographic data presented below. Most cases were in 20-29 years age group (47.55%), with males (51.04%) being more prevalent. Types and methods of poisoning, showing that most cases were intentional (84.61%). Various hospitalization criteria, such as arrival timings, patient state, length of stay, and outcomes, can be used to understand better and handle cases of poisoning. Conclusion: Poisoning wasmore common in young population with organophosphorus poisoning being major cause.  Most of the patients had intentional ingestion. Easy availability of such compounds should be checked. Early presentation and treatment will improve outcome.

DOI: 10.5281/zenodo.10962592

Objectives: The present study was to evaluate the lipid profile and to establish the relation between serums lipid profile and effect of duration of diabetes mellitus on lipid profile in type 2 diabetes mellitus patients. Methods: Fasting and postprandial serum glucose were estimated quantitatively by GOD/POD technique. Total cholesterol was estimated quantitatively by CHOD-PAP technique. Serum Triacylglycerol was estimated quantitatively by GPO-ESPAS technique. High density lipoproteins (HDL-C) were estimated quantitatively by PEG-PAP method. Very low-density lipoproteins (VLDL-C) was estimated from serum triacylglycerol level using Friedewald formula. Low density lipoproteins (LDL-C) were calculated by subtracting serum HDL and VLDL from total serum cholesterol. Results: A total 68 subjects were included in this study. Out of 68 cases, 34 old age (50-60 years) patients of type 2 diabetes mellitus with dyslipidemia were enrolled in group I (DDO) and 34 old age (>60 years) patients of non-diabetic with dyslipidemia were enrolled in case group II (NDDO). FBS and  PPBS were significant higher in  DDO group as compared  to NDDO group.   Mean TC, HDL, LDL, VLDL and triglyceride level were 329.1176±39.6712 mg/dl, 30.2113±1.9887, 222.7635±37.8788 mg/dl, 69.8231±5.8564 mg/dl  and 357.6543±26.7767 mg/dl  respectively in  NDDO group. While in DDO group mean TC, HDL, LDL, VLDL and triglyceride level were 313.8762±35.7865 mg/dl, 27.8341±1.9865 mg/dl, 212.7654±34.8765 mg/dl,  76.7861±2.0341 mg/dl  and 356.9832±35.6703 mg/dl respectively. In  NDDO group TC, LDL, and  Triglyceride levels   were higher but not statistically significant. Conclusions: Diabetes as well as increased age both are affected the lipid profile. TC, LDL, VLDL, and TG are increasing with advancing age and diabetes except HDL is no more increasing with advancing age. Hence, diabetes mellitus accelerates the age-related disturbance in lipid profile. So that, we should organized health check-up camp in urban as well as rural area at time to time for awareness of dyslipidemia in old age diabetic patients.

DOI: 10.5281/zenodo.10962592

Background: The rise of microbial infections and antibiotic resistance in Intensive Care Units (ICUs) represents a significant challenge in healthcare, with ICUs becoming focal points for nosocomial infections, often complicated by multidrug-resistant organisms. This study aims to explore the patterns of microbial infections and antibiotic resistance in ICU patients, with a focus on tracheal aspirates, to enhance empirical treatment strategies and promote antimicrobial stewardship. Methods: A retrospective cross-sectional analysis was performed on 100 endotracheal aspirate samples collected from ICU patients at Jawaharlal Nehru Institute of Medical Sciences, Imphal, between November and April 2023. Samples were processed using standard microbiological techniques, including Gram staining, culture, and antimicrobial susceptibility testing, to identify pathogens and assess their resistance profiles. Results: The study revealed a 75% positive culture rate from the analyzed samples, with a notable predominance of Gram-negative bacilli (70%) over Gram-positive cocci (4%). The majority of isolates displayed multidrug resistance, with significant resistance observed to tetracycline (52.8%), ceftriaxone and ceftazidime (39.9%), amoxicillin-clavulanic acid (40%), and ciprofloxacin (38.6%). Carbapenem-resistant isolates accounted for 31.4% of the total. Klebsiella species and Pseudomonas aeruginosa were the most frequently isolated pathogens, showing high levels of resistance to commonly used antibiotics. Conclusion: The study underscores the urgent need for targeted antimicrobial stewardship and the development of empirical antibiotic policies tailored to local microbiological profiles and resistance patterns. Addressing the challenge of antibiotic resistance in ICUs requires a multifaceted approach, including continuous surveillance and the judicious use of antibiotics. Recommendation: To combat the escalating issue of antibiotic resistance, it is crucial to implement robust infection control measures, promote the rational use of antibiotics, and enhance local surveillance efforts to guide empirical therapy effectively.

DOI: 10.5281/zenodo.10962592

Aims and Objectives: To assess maternal outcome in patient with placenta previa, to assess foetal outcome in patient with placenta previa and to study the distributions of common risk factors of placenta previa. Material and Methods: This was a prospective observational study conducted in The Department of Obstetrics’ and Gynaecology in the tertiary health centre in the Department of Obstetrics and Gynaecology on 50 women with diagnosed placenta previa. Fifty pregnant women with singleton pregnancy with gestational age >28 weeks with diagnosed placenta previa are included in the study. Results: In our study-Mean age was 29.56 years and GA was 35.4 weeks. At the time of admission, 23 patients’ i.e.,46 % belonged to 35-37 weeks of gestation, 20 patients i.e. 40% belonged to 31-34 weeks, 7 patients i.e. 14% belonged to 38-40 weeks. 10 patients. i.e. 20% had grade 1 placenta previa, 16 i.e. 32% patients had grade 32, 18 i..e.36% patients had grade 3, grade 4 placenta previa was seen i.e. 6 patients i.e. 12% ,Out of 16 patients with grade 2 placenta previa 6 patients i.e. 37.5% had anterior placental localization and 10 patients i.e. 62.5% had posterior location. Out of 50 study population invasion of placenta were found in 8 patients i.e. 16% ,out of which 4 patients were found to be increta and 4 Patients were found to be accreta. 42 patients i.e., 84% were found with no placental invasion. Conclusion: The reduced maternal mortality in recent years is mainly attributable to the increased use of blood transfusion, effective antibiotic therapy and better understanding of the management of shock and renal failure.

DOI: 10.5281/zenodo.10962592

Introduction: Middle ear surgery, a delicate and intricate procedure, demands meticulous anesthesia management to ensure optimal patient outcomes. This study aims to compare the efficacy and safety of two anesthesia regimens: Propofol with Dexmedetomidine and Propofol with Fentanyl for middle ear surgery performed under monitored anesthesia care (MAC). Aim: The primary objective is to assess the sedation and analgesia in patients undergoing middle ear surgery with two different combinations. Secondarily, we aim to compare the efficacy of these combinations of drugs to provide a near bloodless microscopic surgical field, hemodynamic and respiratory effects, surgeon and patient satisfaction, and adverse effects. Materials and Methods: This prospective, randomized controlled trial includes 100 patients scheduled for middle ear surgery under MAC. Participants will be randomly assigned to the (Propofol-Dexmedetomidine) Group DP or the (Propofol- Fentanyl) Group FP. Sedation, Analgesia Intraoperative and postoperative parameters like hemodynamic and respiratory stability, postsurgical recovery time, surgeons’ and patients’ satisfaction about quality of anaesthesia, will be closely monitored and evaluated. Results: Group DP had lower intra-operative hemodynamic changes when compared to Group FP, which was statistically significant. Group DP had better quality of the surgical field; surgeons’ and patients’ satisfaction when compared with Group FP. Group DP had reduced need for rescue analgesia. Group DP had significantly and consistently quicker post-operative recovery time. Group DP had lower post-operative pain when compared to Group FP. Conclusion: Propofol-Dexmedetomidine combination is good alternative to Propofol-Fentanyl combination for MAC in middle ear surgery since it produces quicker post-operative recovery time and reducing post-operative pain with better quality of the surgical field and reduced need for rescue analgesia. Propofol-Dexmedetomidine was well tolerated with no clinically significant effects on blood pressure or heart rate.

DOI: 10.5281/zenodo.10962592

Background: Menstruation is an important part of women’s life. Menstrual hygiene is very important by using proper menstrual products and facilities to dispose used menstrual material. A menstrual cup is a small, funnel shaped, flexible, made of silicone, latex, or a thermoplastic isomer that is inserted into the vagina to collect blood during menstruation. It is the most hygienic effective menstrual product. It reduces the burden of sanitary waste and can be used which lasts up to 10 years. It is marketed as an eco-friendly and cost-saving menstrual care. Objective: To assess the awareness, knowledge, practices and acceptance regarding menstrual cup among females of reproductive age group in a rural setting. Methods: A prospective study was conducted among 1000 study subjects among females of reproductive age group in rural setting during September 2023.Data collected from the selected eligible participants by an interviewer administered study proforma. Results: Out of 1000 participants, who took part in the study, among them 600(60%) were between 21-25 years, 200(20%) between 26-35 years and 200(20%) between 36- 45years. Among them 432(43%) knew about menstrual cup, good knowledge 292(67%) were between 21-25years, 96(22%) between 26 -30years,32(7%) between 31-35 years,12(2%) between 36- 45years. Among the users (n=287), 102(35.54%) did not experience any significant side effects. Conclusion: Based on the above study, it was found that while most young women were aware of the menstrual cup, a significant proportion of them did not use it primarily due to sociocultural and personal factors and presence of numerous misconceptions about menstrual cup.

DOI: 10.5281/zenodo.10962592

Introduction: Globally, the prevalence of smartphone addiction ranges from 2.4% to 60.3%.  Smartphone addiction has been found to pose a negative impact on one’s ability to think, pay attention, remember, and regulate emotions. It can also have a negative impact on biological systems, leading to increased stress, sleep disturbances and depression. Medical college students are increasingly developing this behavioural addiction and are liable to suffer its consequences. Objectives: (1) To determine the prevalence and determinants of smartphone addiction among medical students; (2) To assess the consequences of smartphone addiction among medical students. Methodology: A cross-sectional questionnaire-based study was conducted among medical students in Karnataka from February to April 2023. Medical students who were present on the day of filling the questionnaire and those that gave their written consent were included in the study. A pretested questionnaire and the standardized Smartphone Addiction Scale-Short Version were employed. Data was entered in Microsoft Excel and represented as frequencies, percentages and graphs. Chi-square test was performed for association. Results: A total of 521 students were included in the study. The prevalence of smartphone addiction was seen among 74.9% participants. Female students and those staying in the hostels showed a higher prevalence. 98% of the participants agreed that they constantly check their smartphones, 68% of the students reported that other people complain about their increased use of smartphone. There was a significant association seen with decreased sleep duration, sleep latency and subjective academic procrastination.

DOI: 10.5281/zenodo.10962592

Background: Dietary habits are a major aspect of people’s lifestyles that influence health, morbidity and mortality. Patterns of food consumption and their relation to mental health have received some attention in research recently. Students pursuing a bachelor’s or master’s degree have greater freedom over their lifestyles while also being exposed to significant stress. This study was undertaken to discern college students’ pattern of food consumption and its relation to mental health. Objectives: (1) To determine the prevalence of depression, anxiety and stress; (2) To assess the association between dietary pattern and depression, anxiety and stress among degree students. Materials and Methods: A cross-sectional survey was conducted at two select degree colleges in Davangere. Around 200 students were given self-administered questionnaires which included a Food Pattern and Frequency Questionnaire and the DASS 42-item scale. All statistical analyses were performed using SPSS 16.0. Results: A total of 200 college students with a mean age of 18.8 years participated in the study. 53% of them were male. Consumption of sweet and salty junk food was more common among female students (mean scores 8.7 and 13.6 respectively) compared to their male counterparts (8.3 and 12.4). Students showed high levels of depression (76.5%), anxiety (66%) and stress (57.5%). Conclusion: The results showed higher prevalence of depression, anxiety and stress compared to previous studies, and salty junk food consumption was positively associated with these states. Stress was significantly associated with consumption of sweet junk food.

DOI: 10.5281/zenodo.10962592

Background: The experience of parents of newborn admitted to the NICU is really stressful to the parents. Degree of stress experienced by parents, affects their mental health and relationship, and infants’ development. This study aims to assess the stress levels experienced by parents of neonates admitted to NICU and to identify several factors influencing their stress levels. Materials and Methods: This is a cross sectional study done on parents of neonates admitted in NICU of rajindra hospital patiala to assess the amount of stress experienced by parents of neonates admitted in NICU. Parents of neonates who were admitted in NICU for more than 24 h were included in the study (106 mothers and 44 fathers). A semi-structured validated interview-based questionnaire / proforma consisting of Parental Stressor Scale: NICU (PSS: NICU) comprising four sub-scales, and questions related to maternal and neonatal characteristics were used. Results: If the four subscales are considered, most stressful for the parents is the NICU sight and sound (e.g., alarms, monitors), followed by relationship with baby and parental role. This is consistent with other studies by Carter et al. and Musabirema P et al. These studies state that sights, sounds, and the general environment of the NICU causes stress and panic in the parents. The second specific area that caused stress in this study is parents relationship with their child. Conclusion: The results of this study support wider use in research and clinical practice to identify level of parental stress. Interventions can be developed to reduce its negative effects on individual, interpersonal, and societal levels. The stress score was not significantly different in between fathers and mothers of newborn admitted to NICU. Appropriate counseling should be directed toward both mother and father. Future studies should be planned in order to decrease the stress level in parents.

DOI: 10.5281/zenodo.10962592

Background: Melasma, a common dermatological concern, manifests as symmetrical hyperpigmented facial patches, posing cosmetic and psychological challenges, notably among pregnant women. Termed “chloasma gravidarum,” it affects up to 50-70% of pregnant women, particularly those with darker skin tones. Hormonal fluctuations, notably elevated estrogen levels during pregnancy, are pivotal contributors to melasma’s development. Despite extensive research, the precise mechanisms remain unclear. Our study analyzed serum estradiol levels in pregnant women with melasma to elucidate hormonal influences and improve clinical management. Methods: This cross-sectional study conducted over two years recruited 97 pregnant women with melasma and 95 healthy pregnant controls from a tertiary care center in North India. Dermatologists conducted comprehensive clinical examinations, assessing hyperpigmented patches and quantifying melasma severity using the Melasma Area and Severity Index (MASI). Fasting venous blood samples were collected for serum estradiol level quantification using a competitive ELISA kit. Statistical analysis included Student’s t-test for group comparisons, and Pearson correlation analysis to explore the relationship between serum estradiol levels and melasma severity. Results: In our study, demographic characteristics were similar between the Melasma (n=97) and Control (n=95) groups, with no significant differences in age (29.5 ± 4.2 years vs. 30.1 ± 3.9 years, p = 0.306) and gestational age (25.8 ± 3.1 weeks vs. 26.5 ± 2.8 weeks, p = 0.102). Majority of melasma cases belonged to Fitzpatrick Skin Types IV (24.7%) and V (22.7%). Melasma severity varied, with 41.2% classified as Mild. Mean serum estradiol levels were significantly higher in the Melasma Group (125.6 pg/mL ± 20.3) than Controls (118.2 pg/mL ± 18.9) (p = 0.009). Positive correlation existed between melasma severity and serum estradiol levels (r = 0.29, p = 0.025). Conclusion: Our study reveals a significant positive correlation between serum estradiol levels and melasma severity in pregnant women, indicating a potential role of elevated estradiol levels in melasma development or exacerbation. Future research should focus on elucidating underlying mechanisms and developing targeted interventions for melasma management.

DOI: 10.5281/zenodo.10962592

Background: Thyroid disorders present a significant global health challenge, often necessitating thyroid surgeries for both benign and malignant conditions. Objective: This study aims to examine the demographic characteristics, surgical procedures, and postoperative outcomes of thyroid surgeries performed at a tertiary care center in India.  Methodology: A retrospective analysis was conducted on 55 cases of thyroid surgeries, where 88.75% of cases were diagnosed with benign pathologies and 11.25% with malignant pathologies. Various surgical procedures, including hemithyroidectomy, total thyroidectomy, and near-total thyroidectomy, were performed. Preoperative evaluations and postoperative complications were meticulously documented. Results: The study revealed a predominance of benign pathologies, with hemithyroidectomy being the most common surgical procedure. Postoperative complications, such as temporary recurrent laryngeal nerve injury and temporary hypocalcemia, were observed, with higher rates in surgeries for benign lesions compared to malignant ones. Conclusion: The findings underscore the necessity for tailored approaches in thyroid surgery, taking into account the specific pathology and clinical presentation of each case. Emphasizing meticulous surgical technique and diligent postoperative monitoring is crucial for minimizing complications and optimizing patient outcomes.

DOI: 10.5281/zenodo.10962592

Background: Sleep quality has emerged as a significant factor influencing cardiovascular health, yet longitudinal studies elucidating this relationship remain scarce. This study aimed to explore the longitudinal effects of sleep quality on cardiovascular health in adults. Methods: A cohort of 100 adults from Kadapa, Andhra Pradesh, was followed over 24 months. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and cardiovascular health was monitored through clinical assessments. Statistical analyses included logistic and linear regression models to evaluate the association between sleep parameters and cardiovascular events and markers, adjusted for confounders. Results: Poor sleep quality, indicated by higher PSQI scores, was associated with a 12% increase in cardiovascular event odds (Odds Ratio: 1.12, 95% CI: 1.04-1.21, p=0.004). A decline in sleep quality over the study period was observed, with sleep duration and efficiency particularly impacting cardiovascular risk. The effects of poor sleep were more pronounced in individuals under 45 years of age and males. Socioeconomic status also modulated the relationship between sleep quality and cardiovascular health. Conclusion: This study highlights the significant impact of sleep quality on cardiovascular health and suggests that improving sleep quality could be a beneficial component of cardiovascular disease prevention strategies, especially among younger adults and lower socioeconomic groups.

DOI: 10.5281/zenodo.10962592

Background: Ventilator associated pneumonia (VAP) is a common cause of nosocomial infection and accounts for 6.8% to 32.2% of health care-acquired infections among neonates. Mechanically ventilated infants in the neonatal intensive care unit (NICU) are particularly at high risk of developing VAP because of poor host factors, severe underlying diseases, prolonged use of mechanical ventilation, inadequate pulmonary toilet and extensive use of invasive devices and procedures. Methods. This was a prospective observational study carried out at Zanana Hospital, SMS Medical College, Jaipur over a period of one year from July 2012 to June 2013. A total of 100 neonates fulfilled the inclusion criteria, were included in the study and formed subjects. Results: Out of total 100 patients 38 patients (38%) developed VAP according to diagnostic criteria based on clinical and radiologic picture and had positive ETA culture. On bivariate analysis of various risk factors for VAP, including birth weight, prematurity (gestational ages  37 weeks), duration of MV, number of re-intubations and length of NICU stay it was found that very low birth weight (OR 0.062; 95%CI 0.019-0.205; P  0.001), duration of Mechanical ventilation (OR 0.333; P value- 0.0276) and number of Re-Intubations were significantly associated with VAP but there were statistically no significant differences between the two groups with respect to SGA. Conclusion: Endotracheal aspirate can be used to predict the development of VAP by microscopic examination for number of pus cell, gram stain, culture and sensitivity for type of micro-organism.

DOI: 10.5281/zenodo.10962592

The compression and distortion of neural tissue may result in harm to the nervous system caused by space-occupying lesions (SOLs) in the spinal canal. Current methods for diagnosing SOLs rely on histological examination; however, developments in neuroimaging have revolutionized this practice. Intradural, intradural extramedullary (IDEM), and intramedullary spinal cord tumours (IMSCT) are the three primary types of spinal oncology (SOL) that neuro-spinal surgeons often face. Clinically, treating SOLs in the spinal cord is no easy task. Over five years, researchers from India’s Nalanda Medical College & Hospital (NMCH) in Patna looked at the results of SOL surgeries. To evaluate the patient’s postoperative recovery and quality of life, PROMs were used. The research highlighted the significance of tissue diagnosis in guiding prognosis and treatment options since this anatomical location encounters a varied range of diseases. Surgical resection, which is customized based on tumour location and histology, is still an essential part of treatment. Furthermore, the research demonstrated how cytologic preparations and neuroimaging approaches work hand in hand to provide precise and quick diagnosis. Clinical practice and future research will be informed by the results, which add to our knowledge of the causes, symptoms, and treatment options for SOLs.

DOI: 10.5281/zenodo.10962592

Background: Globally, urinary incontinence impacts approximately 200 million individuals, with women being disproportionately affected at twice the rate of men. The International Continence Society (ICS) defines Overactive Bladder (OAB) as a symptom complex that includes urinary urgency, potentially accompanied by urge incontinence, and typically presents with increased frequency and nocturia. OAB substantially diminishes various aspects of life, such as work, sleep, sexual intimacy, and interpersonal relationships. Notably, urge incontinence, a component of OAB, significantly degrades health-related quality of life (HRQL). Methodology: This case-control study involved 100 perimenopausal women, split into two groups: 50 participants displaying genitourinary symptoms formed the case group, and 50 asymptomatic individuals served as controls. We employed a structured questionnaire to assess their genitourinary issues. Result: Findings from the study indicated that while urge incontinence and urgency were exclusively noted in symptomatic women (cases), other genitourinary issues such as frequency, nocturia, and vasomotor symptoms were similarly prevalent in both cases and controls. Conclusion: The study reveals that even perimenopausal women who are asymptomatic may experience urogenital symptoms, highlighting a pervasive lack of awareness and understanding of overactive bladder issues within the community.

DOI: 10.5281/zenodo.10962592

Background: Lipid profile abnormalities are common in both Nephrotic Syndrome and Chronic Liver Diseases, contributing to the progression of these conditions and increasing the risk of cardiovascular complications. Understanding the specific lipid profile patterns in these diseases is essential for developing targeted management strategies. Methods: This retrospective observational study involved 80 participants, divided equally into two groups: Group A with Nephrotic Syndrome and Group B with Chronic Liver Diseases. Lipid profile parameters including total cholesterol, triglycerides, LDL-C, HDL-C, and VLDL-C, alanine aminotransferase (ALT/SGPT), aspartate aminotransferase (AST/SGOT), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) were analyzed. Statistical comparisons between groups were performed using appropriate tests. Results: Patients with Nephrotic Syndrome exhibited significantly elevated levels of total cholesterol, triglycerides, LDL-C, and VLDL-C, and decreased levels of HDL-C compared to patients with Chronic Liver Diseases (p < 0.001 for all comparisons). Liver profile tests reveal more severe liver impairment in Chronic Liver Diseases than in Nephrotic Syndrome, underlining the importance of such tests in diagnosis and management. The demographic characteristics between the two groups were similar. Conclusion: Distinct lipid profile abnormalities were observed between Nephrotic Syndrome and Chronic Liver Diseases. These findings underscore the importance of tailored management approaches for dyslipidemia in each condition to mitigate associated cardiovascular risks and improve clinical outcomes. Recommendations: Clinicians should prioritize regular monitoring of lipid levels in patients with Nephrotic Syndrome and Chronic Liver Diseases. Lifestyle modifications, including dietary changes and physical activity, should be encouraged. Pharmacological interventions, such as lipid-lowering medications, may be warranted based on individual patient characteristics and comorbidities. Further research is needed to elucidate the underlying mechanisms driving lipid abnormalities in these conditions and evaluate the efficacy of different treatment strategies.

DOI: 10.5281/zenodo.10962592